The Pitt Season 1 Episode 2 - Neuropsychologist Reacts

Added: 2026-05-09

[00:00:00]All right. Hello everybody. We are back.

[00:00:02]This is uh Dr. Robert Duff. I'm a licensed psychologist specializing in neurosychology in Southern California.

[00:00:08]We are continuing our rewatch of The Pit. So we are in season 1, episode 2. A lot of interesting things happening from the first episode. There's the kid who ran away with the troubling messages about potentially wanting to hurt people. Um there's that person with Alzheimer's. There's Robbie having flashbacks to, you know, COVID and losing his mentor. Lots of interesting stuff. I honestly don't remember where a lot of these story lines go. So, I'm excited to get back into it. And uh if you haven't yet, please subscribe.

[00:00:36]Please uh drop a comment. A lot of you been doing that. I appreciate it. I want to continue doing this. So, please continue supporting. And let's jump in.

[00:00:51]>> Ready? One.

[00:01:00]Robbie, color skin, respiratory distress is here, >> right?

[00:01:04]>> You okay?

[00:01:05]>> Yep.

[00:01:06]>> That room with the with the paintings, the pediatric room. Um, I think that is an important character in the series as well.

[00:01:15]>> I wanted to talk to the patient at Central 12, but he took off.

[00:01:19]>> Is there a problem?

[00:01:20]>> Uh, according to mom, she found a list of high school girls that he'd like to eliminate. The hell is wrong with kids these days?

[00:01:28]>> Uh, you mean besides social media and the worldwide pandemic and the environmental crisis?

[00:01:33]>> Yeah. Yeah. You're fountain of hope today, aren't you?

[00:01:36]>> Nick Bradley, >> kids uh, and people in general have legitimately been through a lot in the past I mean decade. I don't know. The times continue to be unprecedent unprecedented and unprecedented.

[00:01:53]uh is no joke and there's real stuff that is resulting from that.

[00:01:57]>> Unresponsive by parents. No meds, no allergies. On arrival, he was barely breathing with pinpoint pupils brady cardic at 38. Pupils responded to Narcan, but we tubed him when his respirations didn't pick up.

[00:02:08]>> Heart rate 64, BP is cycling. No response to pain. GCS 3.

[00:02:14]>> GCS is the Glasgow coma scale. Uh lower scores are worse. I don't know the entire scale off the top of my head.

[00:02:22]Anytime I comment on it, I have to look it up. But it's basically how alert uh how responsive somebody is. Um whether they are in a full coma or whether they are fully alert. Those are kind of the the polls of that. So, you know, she's saying he's not responsive to pain.

[00:02:36]That's a pretty low score.

[00:02:38]>> Been any tox?

[00:02:39]>> No. If it was just opiates with Narcan, he'd be breathing on his own.

[00:02:44]>> Where Where are we going now?

[00:02:46]>> We need the room for someone else. But you can rest in the hall till we get your labs back.

[00:02:52]Your >> parents must be proud >> having a son who's a doctor.

[00:02:57]>> Yeah, I guess.

[00:03:01]>> You know, I was the first one in my family to go to college and uh >> so they sacrificed a lot to get me here.

[00:03:09]>> How's your pain, Mr. Milton?

[00:03:10]>> Uh, I'm fine. I could use a latte, though.

[00:03:14]>> Well, that could bring back the gallstone pain.

[00:03:16]>> How about a bourbon?

[00:03:18]>> It's barely 8:00. Uh, how about some ice chips?

[00:03:22]>> No thanks. I prefer my whiskey neat.

[00:03:26]>> Yeah, that's not happening.

[00:03:29]>> Great rapport. Like, uh, chatting and having some jokes with patients is great. Like, it it humanizes you. It humanizes them. It gets you, you know, on the same page in terms of feeling positively toward each other. So, I'm all for it.

[00:03:47]Systolic back down to 90.

[00:03:50]>> Another 0.1 of epi flac paralysis of all four extremities.

[00:03:56]>> No eye movement with ice water.

[00:03:58]>> So no brain stem function >> due to >> hypoxic injury, massive hemorrhage.

[00:04:04]Samra escort him to CT.

[00:04:07]>> Brain stem functioning is massively important. your brain stem. One way to think about the brain is it sort of evolved like back to front. Um as humans we have really large frontal loes that has to do with complex reasoning, problem solving, imagining scenarios, things that humans are really good at.

[00:04:25]Um if you look at kind of lower organisms in their actual brains, uh they look more similar to our brain stem. So you know basic functions like respiration, muscle tone, things like that. um uh alertness, keeping you awake or asleep. So when the brain stem is damaged, you don't really have a lot of functioning in those ways. Basic survival.

[00:04:47]>> Take the drug box with you.

[00:04:49]>> Call me if you need me. Hey, are you okay?

[00:04:53]>> Yep.

[00:04:54]>> You sure?

[00:04:55]>> Have you ever had to worry about me?

[00:04:57]>> No. Uh 68-year-old male, history of hypertension, 1 hour of right upper quadrant pain after eating a fatty meal now resolved. A febrile non- tender.

[00:05:07]There was a gallstone present on pocus.

[00:05:08]EKG shows no acute eskeemic changes, but I'm still waiting on LFTs and lipes.

[00:05:13]>> Why did you order the EKG?

[00:05:16]>> The nurse suggested it to rule out any cardiac issues.

[00:05:19]>> Well, good call on both your parts.

[00:05:22]Nurses know what they're doing. Never hesitate to listen to them. Come find me when those labs are back.

[00:05:27]They do a good job in the show of uh emphasizing that point, right? And I've clearly, you know, met nurses that run the gamut. There are some that are so sharp and so perceptive and are really helping the doctors do their job.

[00:05:41]Without them, they'd be hopeless. And I've met nurses who um can add inaccuracies to the pot. So it not every nurse is created equal, but they are such a vital part of running a hospital or any sort of clinic. And an amazing nurse is such a godsend. Um I don't even believe in God, but I'll say it.

[00:06:03]>> How's that finger?

[00:06:04]>> Oh, it's not.

[00:06:05]>> Dr. Robbie.

[00:06:06]>> Yep.

[00:06:06]>> The son and daughter of Mr. Spencer from Assisted Living. They're here.

[00:06:09]>> Okay, I'll be right there.

[00:06:18]Your father has pneumonia and a condition called sepsis.

[00:06:22]>> What is that exactly?

[00:06:23]>> It means that the bacteria has spread from his lung to his bloodstream. So far, he's been responding well to treatment.

[00:06:30]>> Hey, pop.

[00:06:32]>> I think this is the Alzheimer's patient.

[00:06:34]And if you recall last time I had talked about how if somebody has early Alzheimer's, they're unlikely to have this really really massive confusion yet. And so probably it's something metabolic that's happening. And in this case, they're saying sepsis. So an infection that is causing um you know, probably a temporary state of delirium on top of the physical symptoms, which would be very common. Um in Alzheimer's disease, unfortunately, it's not like the brain suddenly shuts off one day.

[00:07:02]It's complications due to Alzheimer's that end up having somebody die. And so things like getting pneumonia, um aspirating food and that causing pneumonia, uh infections that they're unable to communicate about that are building up under the surface. It is things like this that eventually cause somebody to die with Alzheimer's disease. And so this would be actually a fairly common scenario.

[00:07:25]>> It's Helen and Jeremy.

[00:07:29]Jeremy Hillary Boob.

[00:07:38]>> It's the Nowhere Man from Yellow Submarine. This is what he used to call me when I didn't do my homework.

[00:07:43]>> Is this his baseline?

[00:07:45]>> He has good days and bad days.

[00:07:48]>> Why don't we step out for one more second?

[00:07:52]>> Great question from Dr. Robbie. Uh, is this his baseline? Because when somebody is impaired, you don't really know what would be considered normal for them on, you know, in the immediate or in the past and what would be a change. We're most concerned about things that are a change from the previous baseline, but in the ED, you've never met them before.

[00:08:10]So, great question.

[00:08:16]>> So, your father came in with low blood pressure, which is improving.

[00:08:20]>> Can he go back to assisted living >> eventually? We hope so. Your dad has an advanced directive expressing his wishes which says that IV fluids and medications are okay but no artificial life support and OCPR.

[00:08:31]>> He doesn't want a bunch of machines keeping him alive.

[00:08:34]>> Okay. Then we will continue with oxygen and IV fluids and antibiotics. But if his lungs stop working, we're not going to place a tube in his windpipe for breathing machine.

[00:08:44]>> But pneumonia is treatable.

[00:08:47]>> Most of the time it is.

[00:08:50]>> But if he can get better in a week, then put him on a machine. That's not what he wanted.

[00:08:54]>> Do either of you have durable power of attorney for healthcare?

[00:08:57]>> Yes, we both do.

[00:09:00]>> So, realistic situation. These things are complicated. Um, so if you have durable power of attorney, what that allows you to do is to make decisions on behalf of whoever it is, your family member, loved one. It does not allow you to override their decisions. That would be requiring what's called a conservatorship. So durable power of attorney, you know, means that they could, you know, make some decisions there. Uh, but it does get complicated when it uh comes to life-saving procedures, advanced directives, and all of that. It can be often a question that is not totally clear in the answer in that moment. Like if you were in a life or death immediate situation, it's not uncommon for doctors to accidentally make technically the legal like incorrect move if they were to consult their lawyer or something like that because they simply don't have time and they're going off of their knowledge of this. And if there are layers to, you know, who has decision-m power and who can change things, etc., it can be complicated.

[00:09:58]>> Okay. Well, this is a decision that does not need to be made right now. Why don't you think about it?

[00:10:04]>> Talk about it.

[00:10:05]>> If Things get worse.

[00:10:08]>> Sometimes allowing for a comfortable natural death can be the most humane path.

[00:10:12]>> How'd you choose the pit?

[00:10:14]>> Oh, I have a sister with special needs and she got into this really great facility here in Pittsburgh and PTMC has such a great reputation. I thought, you know, it'd be a good >> Can I present my headache to you?

[00:10:23]>> Uh, yeah. What do you got?

[00:10:25]>> 36-year-old woman with severe headache due to paraserical trigger point. Her pain went from 11 to zero after 2 cc's of IMR.

[00:10:32]>> Wait, wait, wait. You did a trigger point injection before presenting the case? Yeah, >> interns always present first.

[00:10:38]>> I spent a month at the pain clinic. Very comfortable.

[00:10:41]>> It's definitely not okay.

[00:10:44]>> That's the start of this uh tension between Langden and Santos. Obviously, it plays out in various ways throughout the series, but um yeah, you know, protocol is protocol. Even if something is um you know, reasonable to do, they if they're supposed to present before treatments, that's what they're supposed to do. you know, for an intern of mine.

[00:11:05]Obviously, these are not medical procedures, but if they sort of suddenly decide to not give a certain test or to change something or to change standardization on a given test and I'm not consulted about that, I would yeah, I would have something to say about that. Probably not in that way. Um, he's a little angry there. And yeah, it's it's you know, you I talked about these things ahead of time. And then let's not forget this is these interns uh first day. So that would be very bold.

[00:11:35]>> 23-year-old Ben Kemper, no helmet, got door riding an e scooter. Neck versus handlebar, then face planted to the pavement. Obvious facial fractures, but alert and oriented with good vitals.

[00:11:44]>> How we doing, Ben? What? Back in my throat.

[00:11:48]>> That's probably from the nose bleed.

[00:11:50]Short rapid rhino, please.

[00:11:52]>> Tacky at 120. Pulseox borderline at 90.

[00:11:55]>> We'll buy at 15 L for now.

[00:11:56]>> Neck contusion. Lar shifted to the right. No creepance.

[00:12:00]>> Four of morphine. I'm going to stick something in your nose to stop the bleeding.

[00:12:06]>> No hemotimp.

[00:12:08]>> I think he's doing a rhino rocket.

[00:12:10]Unfortunately, I have personal experience with these. Uh I had a really freaky incident where I got this severe bloody nose. I never get them and it would not stop. Um and I ended up going to three different hospitals in three different days because I was uh traveling from where like my parents live up to where we live. And so I hit different hospitals on different days throughout the way. And they had to uh do a rhino rocket. So it's basically like a inflatable thing. They shove up your nose. They also didn't know at the time that I had uh some polyps in there.

[00:12:43]So they basically like rammed them through the polyps. They did one side.

[00:12:46]Eventually had to do both. And that was one of the most painful things I've I've ever experienced. It was it was hell.

[00:12:53]>> Inflate the balloon.

[00:12:55]>> How about now, Ben?

[00:12:58]better.

[00:12:59]>> What's up?

[00:13:00]>> Uh, good vitals. AO. Let's have a look.

[00:13:04]>> Other oriented.

[00:13:09]>> Ow. Floating face.

[00:13:12]>> Fourth refracture.

[00:13:17]>> Nice work.

[00:13:19]Thanks. All right, Mr. Chagari, you are good to go.

[00:13:23]>> Oh, thank you. Remember, 10% off for doctors and nurses.

[00:13:28]>> I'm a student doctor.

[00:13:32]>> I don't even need to I don't even need to comment on that.

[00:13:35]>> All right. Sorry, I hit my head.

[00:13:37]Remember?

[00:13:38]>> How many kids do you have?

[00:13:39]>> Just one. Harrison, he's 11 now.

[00:13:43]What does your husband do? No husband.

[00:13:46]Just me and my son.

[00:13:48]>> A lot of assumptions flying around here, right? Like assuming she's a nurse, assuming she has a husband. You know, there's ways to ask about this stuff that isn't so assumptive.

[00:13:57]>> I take you don't have kids. I I don't mean on account of your age or I know.

[00:14:02]Maybe I do. I mean, most medical students don't have kids. Um Yeah. No.

[00:14:06]No. Um no kids. Just not even a boyfriend. Just it's just school for now. Yeah. That'll keep you pretty busy.

[00:14:14]I do not miss it. Facial lack with the possible foreign object in the eye, which is always a solid seven on the WMBB scale. What makes Matteo vomit?

[00:14:33]You okay?

[00:14:35]Yeah. Yeah. Um, he's funny. The the nurse. Oh, Matteo, you can say his name.

[00:14:44]Um, yeah. Uh, a foreign object in the eye could be really serious.

[00:14:51]>> So awkward.

[00:14:56]>> Hey, fruit cake.

[00:14:59]>> I forgot all about her. Oh, man.

[00:15:02]>> Hey, I'm talking to you, fruit cake.

[00:15:04]>> Fair enough. I've told you hundred times my name is Dr. Robbie.

[00:15:08]>> You want to see my vagina?

[00:15:10]>> I have already seen it, and once was enough. Thank you, >> Robbie. Parents of Nick Bradley the OD teen are here.

[00:15:18]>> Okay. Parkman trauma one. He's not back from CT yet.

[00:15:22]>> Um, in my field of work, uh, people that are so uninhibited often have, uh, issues with their frontal lobe, I talked about frontal lobe earlier, but, uh, something like fronttotemporal dementia where it degenerates, similar to Alzheimer's disease, kind of just starting in a different part of the brain, or maybe stroke or brain injury to that part of the brain. uh it causes them to not have a filter and so I have heard similar things. Um, there was one patient that it it was very sexual, like not overtly coming on to me or anything like that, though that can happen, but it was more like, you know, talking about her past sexual experiences, things, weird things about her body, nothing having to do with what we should have been focusing on. It was just this uninhibited flow of thoughts. So, that reminded me of that.

[00:16:12]>> I'll be right there in a minute. You >> behaving yourself, Marta?

[00:16:14]>> Oh, yes, ma'am.

[00:16:17]Get ready to bag the crack.

[00:16:20]>> Yeah, yeah, yeah. Good.

[00:16:29]>> Oh, excuse me. No worries.

[00:16:32]>> Foreshadowing.

[00:16:35]>> End title CO2 is yellow.

[00:16:36]>> Yellow is Yes. Nicely done. Sew it in.

[00:16:38]Okay. I will be next door. Just received word your son's head CT is normal and he's maintaining a good heart rate blood pressure.

[00:16:48]>> Thank you. Thank God.

[00:16:48]>> Right now he's unconscious with a tube in his throat for oxygen.

[00:16:53]>> Why don't we step out for a minute while they get him settled and then you can come back. You can sit with him as long as you want.

[00:16:59]>> Nikki, it's mama. I'm here. Babe, >> you're doing great, son.

[00:17:03]>> Blown.

[00:17:05]>> Blown pupils. Not good.

[00:17:09]Okay, let's step outside.

[00:17:18]So, we don't know how long he was at home without breathing.

[00:17:22]>> He's breathing now.

[00:17:24]>> Not on his own, >> but he's going to wake up.

[00:17:26]>> We certainly hope so. We're going to know better after we get some more test results back. Are you sure that he didn't take anything that could have caused this?

[00:17:35]>> No. No. He's a good kid. He's in college. He has a part-time job. He even chose to live at home so he could focus on school.

[00:17:42]>> Dr. Robbie from the urine >> with that.

[00:17:46]>> It's a drug test and it is positive for fentinel.

[00:17:50]>> No, that is impossible. Nick doesn't do drugs.

[00:17:54]>> Always a possibility, right? These all these things are not mutually exclusive.

[00:17:58]Being a good kid, being a high performer, that does not mean that somebody might not be susceptible to um you know taking drugs. you once or habitually.

[00:18:11]>> There are a lot of pills that are sold illegally that have fentinyl, not just painkillers. Xanax had a van.

[00:18:17]>> No, not our son.

[00:18:19]>> Well, maybe he didn't know that he took something with fentinel. I don't know.

[00:18:23]The how's and the wise don't really matter. But Banners is spending time with Nick. We've got some more tests to run. We'll know our options after that.

[00:18:29]But in the meantime, why don't you take a seat, talk to him.

[00:18:35]>> Dr. Robbie knows where this is going, so he's encouraging them to to spend time with him. Uh cuz that outlook isn't good.

[00:18:43]>> Can you hear us?

[00:18:44]>> You know, we're never really sure. So, we should just assume that he can and we'll come find you as soon as we know more. Okay. See, >> can we move Nick Bradley to a private room?

[00:19:00]>> Think you're going to make it?

[00:19:03]>> Can you respond to Nan? I think his pinpoint pupils just grew into blown pupils from brain stem death.

[00:19:08]>> [ __ ] >> Yeah. Not much older than Jake.

[00:19:14]>> Don't go there.

[00:19:16]>> Hard not to sometimes.

[00:19:19]>> Yeah. So that's what he was saying.

[00:19:21]Blown pupils due to brain stem death.

[00:19:23]Brain stem death is not recoverable.

[00:19:27]>> Mr. Spencer's room.

[00:19:29]>> Mr. Spencer, how are you feeling? I don't remember where I parked.

[00:19:34]>> Mr. Spencer, do you know where you are?

[00:19:36]>> It's so loud in here.

[00:19:39]>> Uh, in a situation like this, uh, when you're there present, turning off the monitor sounds a very good idea cuz it can be extremely agitating and overwhelming, especially to a confused person.

[00:19:49]>> Dad, do you know where you are?

[00:19:51]>> Dad, look at me. What's my name?

[00:19:54]>> I don't know where my car is.

[00:19:58]>> His lungs are filling up with fluid.

[00:19:59]Can't you take the fluid away?

[00:20:01]>> Not without his blood pressure crashing with very bad consequences. So, let's just hope the biap works.

[00:20:06]>> And if it doesn't, >> then I would need to know your decision about using a breathing machine.

[00:20:12]>> We're still talking about it.

[00:20:14]>> Well, we know he expressed his wishes in writing. Do not intubate.

[00:20:18]>> We're thinking try it for a week.

[00:20:21]>> That would be a very painful week. He wouldn't get a lot of rest with all the monitors and all the blood tests. He might need to be sedated. He might need to be restrained because he'd be in an unfamiliar place with a very uncomfortable tube down his throat.

[00:20:36]>> Yeah. Like uh it sounds harsh or blunt, but that's totally valid to talk about.

[00:20:40]That is the reality of the situation.

[00:20:42]Like he would be in a living hell for that period of time and it uh begs the question of, you know, who is this for?

[00:20:50]Is this these life-saving measures? Is this for him or is this for the family?

[00:20:56]And also, let's say that he does get through it and recovers. What is his quality of life after that? What are things like if he does survive this for the time that he has left? Like, let's not forget he has Alzheimer's disease.

[00:21:09]The life expectancy for someone with Alzheimer's disease is somewhere around the 8 to 10 year range often. So, there's a lot to think about there. And obviously, emotions are high, but Dr. Robbie is doing a good job of maintaining a cool tone, being factual but empathetic. Um, this is where he's at his best, I think.

[00:21:29]>> And he wouldn't really know what was happening.

[00:21:32]>> Elderly patients can often develop psychosis.

[00:21:35]>> But he might get better.

[00:21:37]>> Or he might get worse.

[00:21:39]What would you do?

[00:21:41]>> I really can't answer that for you. This is your father. That's your decision to make. I can guarantee you that we will keep him as comfortable as possible if a natural death is what you choose. But he's not your father and he can recover from this.

[00:21:53]>> What my sister means is that we're still deciding the best thing to do.

[00:22:00]>> Well, the sooner you decide, the better.

[00:22:02]I'm really sorry. I wish there was more that I could do. I'm not sure that he has that much time left.

[00:22:13]My version of this in my work is not that immediate but I am often faced with the question from families of how long do they have and I can't give an answer to that often but I can say you know the typical life expectancy for a condition like this how long it may have been progressing for and be honest about the fact that you know maybe we don't have 5 years left and you know there are some things to consider before then. So it's always hard to deliver rough news but it's important to be honest with people and and clear in your communication. Uh I think a lot of people would be vague and try to shy away from things because they don't want to have to face that and it's better to be honest if you can.

[00:23:00]>> This is the thing about emergency medicine. You never know what you're going to get and we get everything. Is that why you chose it? H maybe a little.

[00:23:07]I also get to pick my ships, which for a single mother is amazing. But mostly, I just like the people, you know? They're always there when you need them. Who wouldn't want to be a part of that, you know?

[00:23:30]This is the monitoring center. We see that you're not in your inclusion zone.

[00:23:34]Do you have permission to be outside this area?

[00:23:36]>> Yes, I am at work just like last time and the time before that.

[00:23:42]>> One of the things that I preach about the pit is its diversity in characters, right? I I may have mentioned this before, but like racially diverse, um, in terms of, you know, sexual orientation, gender, age, uh, you know, status in terms of, uh, you know, having legal involvement. uh they they do a good job of including a lot of things that are not the primary plot point but are just color and texture to the story and I really appreciate that.

[00:24:12]>> Sorry.

[00:24:13]>> You're doing great. Take your time. You okay?

[00:24:16]>> I amum I get frustrated when I can't do things or at least it looks like it.

[00:24:21]>> Yeah, you and me both.

[00:24:23]>> Thanks. But um my frustration manifests itself emotionally and then I get upset and then it looks like I can't handle things and you know then I can't cry in front of the patient cuz no one wants to see their doctor cry. That's just a big red flag.

[00:24:35]>> You you just hit a perfect crank. You're doing great.

[00:24:39]>> All right. Uh we looked at the board during episode one.

[00:24:44]Um we have pererectile abscess. That's a new one I think. Hyperalemia waiting dialysis. That was uh uh that guy, the athlete guy.

[00:24:58]Hypermesis.

[00:25:00]Um waiting ICU bed, awaiting ICU bed, awaiting CT, code sepsis. Uh DNI do not intubate update for TEDAP. Again, it's everything. Uh they put the BPAP on the code sepsis above that.

[00:25:18]Repeat CT. Repeat Zopran. Lung listen.

[00:25:21]Awaiting family. Awaiting PES. Admit ortho. Awaiting test. Intubated. Nerve block. Awaiting labs. Repeat zip prea.

[00:25:29]So not too much change to some additional stuff.

[00:25:34]Let's go.

[00:25:35]>> Caucasian male approximately 60 to 70 years old. Found unresponsive. No signs of trauma. No ID.

[00:25:43]>> On three. One, two, three.

[00:25:49]So, suspected age, meaning they don't know his age, no ID. Um, they're noticing the smell. You know, the the assumption is potentially unhoused.

[00:26:01]>> Did you take anything?

[00:26:03]>> Smell the alcohol from here. This guy's wearing the spring, summer, and fall collection.

[00:26:08]>> JEEZ.

[00:26:12]>> UH, what's wrong? What's going on?

[00:26:16]patient tested positive for rats. No, >> I totally forgot about that plot point.

[00:26:23]>> If it matters, I only counted three.

[00:26:25]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.

[00:26:33]>> What about his brain? Is there a chance that much pot is going to do some damage? I mean, he's only four.

[00:26:39]>> The honest answer is we don't know.

[00:26:41]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.

[00:26:47]>> As far as I know, the state of the research right now is that like chronic use over time, especially high amounts during formative ages, so this is usually adolescence, hopefully not childhood of THC can have some degree of lasting impact. Um, in adults, chronic use over long periods of time can have some effects that usually go away once it's no longer used, but during those developmental periods is where you want to be more careful. Again, this is a one-time thing. Uh, probably not a big concern for permanent damage.

[00:27:19]>> Like, you don't know.

[00:27:20]>> So, my son could end up with learning disabilities, psychiatric problems, or even autism because there's no evidence to suggest any of that.

[00:27:27]>> Hello, I'm Kiara Alaro. I'm the department social worker. Kiara will help you navigate the next steps.

[00:27:35]>> What >> they're probably going to have to do a child protective services report. Um even if it's something they know was an accident, even if it's something that was, you know, essentially benign in intention, they're depending on their laws there, it may be something that automatically has to be reported. Maybe it won't really be investigated, but it has to be reported potentially.

[00:27:54]>> Steps.

[00:27:55]>> Well, a case like this uh requires mandatory reporting to child services and sometimes law enforcement. No.

[00:28:01]>> Why? Why do you have to involve the police?

[00:28:03]>> A controlled substance.

[00:28:04]>> They're not taking my kid away.

[00:28:07]>> [ __ ] your suggestions. No one IS TOUCHING MY CHILD.

[00:28:10]>> This is where they need to separate out you like control the situation, right?

[00:28:14]Bring them to a separate room with the social worker. Talk through the reality of what the situation is. You know, what may or may not happen. Um misconceptions about the fact that, you know, your kid's going to get swooped and taken away. So, they need to control the situation a little bit more than just having everybody in there kind of talking over each other.

[00:28:34]>> In fact, we're leaving.

[00:28:35]>> Well, you know, you can't take your son.

[00:28:37]You can stop breathing. You got >> I'll observe him at home.

[00:28:39]>> Amanda, >> [ __ ] off, Drew.

[00:28:41]>> Get security. If you can't cooperate, I'm going to have to ask you to leave.

[00:28:44]>> Amanda, please. He needs to stay here.

[00:28:46]>> And you need to get a [ __ ] hotel.

[00:28:48]>> Your son can't leave the hospital, but I can have you removed.

[00:28:50]>> Don't you DARE TOUCH ME. GET OUT OF HERE.

[00:28:53]>> MRS. JONES, I know this is scary and stressful.

[00:28:56]>> Oh, [ __ ] you. [ __ ] you. This is my son.

[00:28:58]My son. AND NOBODY IS TOUCHING ME.

[00:29:00]>> WHOA, WHOA, WHOA. What's going on?

[00:29:01]>> Worried about to see what happens. OKAY.

[00:29:04]OKAY.

[00:29:06]>> THIS is a hospital. This isn't the Jerry Springer show. Ma'am, nobody's trying to take your child.

[00:29:12]>> Uh given what we know happens at the end of season 2. Him saying that is rich.

[00:29:18]But, you know, sometimes you got to break through the noise.

[00:29:21]>> So, why don't you stay here with him while your husband talks to our social worker outside and straightens all this out. Is everything all right out there?

[00:29:28]>> Yeah, just another day in paradise. How are you feeling?

[00:29:31]>> Better. Where's David?

[00:29:33]>> He left. He said he had to get back to school.

[00:29:37]>> What?

[00:29:38]>> Um maybe you could try calling him, get him to come back.

[00:29:45]>> So, this one is again a complicated one.

[00:29:47]Some people asked, you know, would they be allowed to sort of detain him at the hospital, the son that that ran away?

[00:29:54]And to be honest, I'm not completely sure of the answer in this context. I don't think they would be able to detain, but depending uh they may need to uh report or like warn given again that that kind of teras off duty that I was talking about before. Uh maybe I'll do a deeper dive into that if you guys would be interested.

[00:30:14]>> What's going to happen to him if I do?

[00:30:17]>> Hopefully, he'll be willing to talk to somebody.

[00:30:19]>> Will you talk to him?

[00:30:20]>> I can try. I don't think he wanted to talk to me.

[00:30:24]Have you shared with anyone about the writings of his you found?

[00:30:29]>> No, I didn't know who to tell. I just don't want to see him get hurt.

[00:30:35]>> Neither do we. Do you think he would hurt anyone?

[00:30:37]>> No.

[00:30:41]>> But I'm sure a lot of parents felt that way before their children did unspeakable things.

[00:30:52]>> Keep trying to reason. If you do, have someone come find me.

[00:30:55]>> Okay.

[00:30:57]>> Thank you.

[00:30:58]>> Of course. You got some good news for me?

[00:31:01]>> I think he's essentially trying to do this sort of like the easy way. Like if he can if they can get him back, if they can interview him and actually get some info, uh, that's going to be sort of the path of least resistance. So, he's hoping on that.

[00:31:13]>> Sure do. There are two rooms in ICU being clean. They'll be ready by now.

[00:31:17]>> Great.

[00:31:17]>> And I got bagels in the lounge.

[00:31:18]>> Nice job. Thank you.

[00:31:24]DRONE seeeking woman kicked off a city bus for disrupting and disturbing passengers screaming for narcotics non-stop and found an empty pergo.

[00:31:33]>> I remember this case uh little difficult to watch. Um we talked about assumptions earlier. Sometimes these assumptions are relatively benign. Other times they are um very harmful, right? And that's where something like a microaggression can kind of turn into a macroaggression. And uh I remember how this ONE PLAYS OUT.

[00:31:55]>> HE'S BEEN uncooperative and combative since WE PICKED UP.

[00:32:00]>> STOP FIGHTING. Calm the [ __ ] DOWN ON THE COPS.

[00:32:03]>> MY HOME AREN'T WORKING. PLEASE. I HAVE SICKLES.

[00:32:06]>> OKAY, STOP EVERYBODY. STOP.

[00:32:11]>> What's your name?

[00:32:12]>> Is Joyce Is saying >> Joyce? Is this your sick assol?

[00:32:17]>> Yes.

[00:32:18]>> 10 milligs of ibmorphine.

[00:32:19]>> You really want 10?

[00:32:20]>> Yes. Repeat it in 5 minutes if needed.

[00:32:22]And she needs a diloted drip. This is a vasclusive crisis. I'm so sorry this happened. You're going to be okay now.

[00:32:27]>> We're safe here. Come on. Going to be safe here. I promise. Just breathe.

[00:32:32]Okay.

[00:32:35]>> Yeah. So, she's having a cickle cell crisis. Um, and you notice when they brought her in, they said drug seeeking female. Like, [ __ ] off, guys. Um, but yeah, these preconceptions do lead to disparities in treatment and that sucks.

[00:32:52]So, there's a great example of advocating for your patient and yeah, she's a badass.

[00:32:56]>> Sorry.

[00:32:58]>> So, what what happened?

[00:33:00]>> I bought it for my girlfriend's dog. I work nights and he yaps all day long and when I woke up, I was wearing it. Stupid [ __ ] Sorry. Sorry.

[00:33:22]>> I think she must have used crazy glue.

[00:33:25]>> Yeah, it um it looks that way.

[00:33:28]Have you tried removing the batteries?

[00:33:30]>> Of course, she glued the case shut.

[00:33:34]>> All right. I think we have a couple options.

[00:33:37]>> I don't remember how this one resolves.

[00:33:39]If it were me, um, uh, I would probably get a like a Dremel and like drill into it, you know? Um, I know that's going toward the neck, but you can get in there just a little bit and see if that will, you know, scrub the electronics enough. Um, kinky >> scary. Um, we can try to find a solvent that will dissolve or at least soften the glue enough for you to peel it off without taking your skin with it. or um Dr. Funny. Um I I guess when your your skin cells on your neck will naturally slough off and you should just be able to remove it in time.

[00:34:18]>> How much time?

[00:34:19]>> Um couple weeks maybe.

[00:34:21]>> Couple weeks.

[00:34:22]>> I think this guy's got scurvy.

[00:34:24]>> Was he a pirate?

[00:34:25]>> No, he's non-housed man. Lives almost exclusively on dollar store ramen.

[00:34:29]There's perapolicular hemorrhage, gingivitis, bleeding gums, and um yeah, no fruit or vegetables in his diet. I suppose that could do it as long as you've ruled out piracy. No parrot, no peg leg. Doesn't wreak of sweat and rum.

[00:34:42]>> Well, now that you mention it, there was a smell.

[00:34:44]>> Probably a pirate.

[00:34:47]>> Tell him to pick up some vitamin C next time he ducks at a dollar store.

[00:34:52]>> I can't tell if you're joking.

[00:34:54]>> No, Captain Scy's got a vitamin C deficiency. Cheapest way to fix it is with a daily supplement.

[00:34:59]>> Captain Scurvy's another joke.

[00:35:01]>> I'd like to think so.

[00:35:02]>> That's a good one. Dr. throughout the whole series. Um, you know, we know Mel's sister has autism and Mel never really acknowledges her own neurode divergence, uh, but she makes a lot of comments that really allude to it, like how she, you know, doesn't like making mistakes when she was doing that procedure with the Kri. Uh, here her not understanding or kind of having to use a wrote understanding of the sarcasm and the humor. And yeah, it she she's a great character, very endearing, but it's interesting. Um, I don't know if she acknowledges that in herself, if she doesn't see it, if she's in denial of it. It's never, to my knowledge, really been addressed in the show.

[00:35:43]>> And Dr. King, this is Arthur Carlson from Children, Youth, and Families. He'd like to speak to the parents of Tyler Jones.

[00:35:48]>> Right. Right. So very commonly, you know, if you report to adult protective or child protective uh services, whatever the name locally is for, you know, where you live, you're going to have a social worker typically come out to investigate uh the situation.

[00:36:04]>> Right. Uh Mel, would you mind showing him to Kiara and the family?

[00:36:07]>> Yeah, right this way.

[00:36:09]>> Hello, doctor. What are you doing here?

[00:36:11]>> I'm working day shifts now.

[00:36:13]>> Didn't you retire a couple years ago?

[00:36:15]>> No, I have to work today.

[00:36:18]>> Great.

[00:36:19]Right. Just stay stay right here. Okay.

[00:36:21]I >> I have a lot of cleaning to do. Yeah.

[00:36:23]No, I'll I'll be just one second. Hey, >> potentially another Alzheimer's person.

[00:36:28]Um that would be very common. I have had people who returned to the places that they used to work. Um recently had somebody who is has been, you know, going onto farms they used to work at and actually taking produce uh because they thought they still work there. I'm not sure if that's this guy's situation.

[00:36:46]I don't quite remember.

[00:36:47]>> Doc. Doc, how about a sandwich?

[00:36:49]>> Sure, Earl. Turkey, no egg salad. I got you. Just give me one minute.

[00:36:55]>> So, Beter said he's working here.

[00:36:57]>> Yeah, he just started wandering.

[00:36:58]Fortunately, always winds up back here.

[00:37:00]Thinks he still works in the ED. I called his family. They usually pick him up after a few hours.

[00:37:05]>> Really?

[00:37:05]>> Oh, no idea.

[00:37:06]>> Yeah. Gives him a break. And look at him. He's talking to people, feeling useful, getting some exercise. Hell, I wish I was that happy.

[00:37:13]>> No harm, no foul.

[00:37:15]>> Think he's any good at catching rats?

[00:37:16]Stop.

[00:37:18]>> How's the pain, Joyce?

[00:37:19]>> Oh, a little better.

[00:37:22]>> You've ordered an exchange transfusion.

[00:37:24]>> Figured I needed that.

[00:37:26]>> What's your normal regimen at home?

[00:37:29]>> 90 of extended release morphine every 12 hours and oxycodone for breakthrough pain, but it wasn't working.

[00:37:38]>> Starting IV diloted up for an hour. You can press this button if you need a little extra. Uh, that only works once an hour though, so don't go crazy.

[00:37:47]>> Could I confer with you?

[00:37:48]>> Yeah.

[00:37:52]>> A good teaching moment about to happen.

[00:38:00]>> You seem surprised by the opiate dosage.

[00:38:03]It >> seemed a little high.

[00:38:04]>> So was her pain.

[00:38:06]>> How do you know she's not drugy?

[00:38:07]>> Can't fake a hemoglobin of six. Do you know what cickle cell crisis does to the body? Bloods get caught and plug up your capillaries and deprive all your cells of oxygen. It's been described as an electrical stabbing pain that feels like it's breaking your bones and flushing glass through your body.

[00:38:21]>> Okay. I never thought of it like that.

[00:38:24]>> Little empathy goes a long way with those suffering in real pain.

[00:38:28]>> Yeah, I don't think so.

[00:38:29]>> Yeah, >> don't worry. You'll get good at spotting the fakers. And half the time, all those people need is someone to really listen to them and hear their story.

[00:38:36]>> I love her character. Um, you know, going back to the idea of actually hearing somebody out like in the last episode, uh, yeah, a little empathy goes a long way and not assuming you know what they need goes a long way.

[00:38:52]>> This is the path to avoid the median nerve and all major vessels.

[00:38:58]>> Maybe just watch the first time.

[00:39:00]>> She'll hold the blade. I'll cut templated Dr. Santos.

[00:39:07]We'll start proximal.

[00:39:10]>> How much pressure?

[00:39:12]>> Just about this much.

[00:39:15]>> Foreplay.

[00:39:20]>> How are they making out?

[00:39:22]>> They're still talking.

[00:39:25]>> You okay?

[00:39:26]She's probably seen her fair share of, you know, social workers and various uh agencies related to uh childhood and adults with developmental disabilities.

[00:39:36]So, I wonder if this does anything for her seeing, you know, this play out.

[00:39:40]>> Yeah, for sure. I just hate seeing families torn apart.

[00:39:44]>> Oh, they'll be fine.

[00:39:45]>> How can you be sure?

[00:39:46]>> They're white. Probably get off with a slap on the wrist. If they weren't, she'd probably lose her child and he'd end up going to jail. I'm sorry we had to move you into the hall. I know it gets pretty chaotic and noisy out here.

[00:39:58]Mr. Milton.

[00:40:01]>> Hey. Hey, Bennett. Wake up for me.

[00:40:05]>> Rubbing his chest to try to get a reaction.

[00:40:09]>> Oh [ __ ] [ __ ] [ __ ] Um, I need a little help here.

[00:40:13]Help.

[00:40:14]>> When did you check on him last?

[00:40:15]>> I don't know. Around half an hour ago at most. I was wait >> those chest compressions look way too fast.

[00:40:21]>> Thing on labs.

[00:40:21]>> What's going on?

[00:40:22]>> It's my Goldstone guy. You saw a ZKG.

[00:40:24]>> Unknown downtime. He was sleeping in the hall.

[00:40:26]>> Crash guard. Let's go.

[00:40:32]>> I got it.

[00:40:36]>> Oh, compressions.

[00:40:40]>> Assistantly, resume compressions. Amp of epi.

[00:40:45]Slow. Slow tempo. Slow temp.

[00:40:46]>> Should I intubate?

[00:40:48]>> Thanks, Dr. Mike.

[00:40:49]>> No. Drop it down in there. We don't want to hold compressions.

[00:40:54]Oh yeah, >> we switch out every few minutes. You can take a break.

[00:40:59]>> I'm fine.

[00:41:00]>> Hold compressions.

[00:41:03]>> Still in asy.

[00:41:05]>> Resume compressions.

[00:41:07]Well, should we shock him?

[00:41:09]>> You don't shock asy.

[00:41:10]>> We could be fine. Vib, >> not a chance.

[00:41:13]>> Okay. Uh, when was his last EP?

[00:41:16]>> 3 minutes ago.

[00:41:16]>> Okay. Well, ACLS says every 3 to 5 minutes, right? So, let's push another ramp.

[00:41:20]>> Fine. Robbie, Mr. Spencer's adult children are >> He's having a hard time accepting the fact that he's probably losing this patient, and for good reason, right? Um, [ __ ] happens. But, uh, you know, he could have monitored him more. It's not necessarily his fault. It's a little more of a systemic thing, but uh, yeah, that's a that's a tough one.

[00:41:40]>> Asking for you and the parents of Nick Bradley, the fentanyl overdose, also want to speak with you.

[00:41:46]>> Three rounds of EP and then call it.

[00:41:49]>> Mr. Dispensers maxed out on bipap 25 on 10 >> sats.

[00:41:53]>> Not great. Hi 80s.

[00:41:55]>> Was that >> hi? I heard you wanted to talk to me.

[00:41:59]>> Yeah, that alarm kept going off.

[00:42:01]>> Yeah, why don't we step outside?

[00:42:05]The alarm is for low oxygen.

[00:42:07]>> Does he need more of that um bip?

[00:42:09]>> I'm afraid that's as high as we go. So the decision at this point, >> we want you to put our father on the breathing machine.

[00:42:18]Even though that goes against his desires to not be intubated, >> we're not ready to let go yet.

[00:42:24]>> And if your father is, >> he he was a stubborn son of a [ __ ] He would never have given up on either of us. We're not giving up on him.

[00:42:36]>> That's a good rationalization, but really what they're saying is they are not ready yet. he uh has expressed his wishes and he also is in for a horrible time trying to fight through this. So Dr. Robbie cannot you know tell them what to do but he's going to strongly urge them to do what you know from his clinical perspective may be the the more benign thing.

[00:43:04]>> You're absolutely certain you want to put your father through this after everything I've told you.

[00:43:12]I may have to honor his advanced directive.

[00:43:17]>> No, you have to honor our durable power for healthcare. If not, we can talk to your hospital attorney.

[00:43:26]>> Jeremy, you're on board with this.

[00:43:29]>> Yeah, I guess so.

[00:43:33]>> Okay, you can sit with him until we're ready.

[00:43:35]>> When will that be?

[00:43:36]>> Momentarily.

[00:43:40]So that's like I said where he's like uh we may have to you know respect his wishes. It's complicated. Uh the the the answer is not abundantly clear. It's a it's a legal question at that point.

[00:44:01]>> Please don't tell me you're going to intubate that poor man.

[00:44:04]Another point for that actually is sometimes uh people in my position are required to do what you might call like a psychological autopsy. Um in this case more about neurological symptoms. So for example, let's say he made his advanced directive uh several weeks before this happened. We might have to go back and look at records to try to determine given his stage of Alzheimer's, was he having capacity to make that decision?

[00:44:33]and write that uh you know uh advanced directive at that time or was he already impaired and that was probably going against his former wishes but it's a symptom of his neurological disorder.

[00:44:46]Again these things can be very complicated and uh you know if there was a court case that moved forward this is the kind of thing that would probably happen. It's >> what the family wants. So what? They want to torture him?

[00:44:57]>> I explained all that.

[00:45:00]>> If I cosign, we can override their durable power.

[00:45:04]>> They're threatening to go to the hospital attorney.

[00:45:06]>> Let them call the ethics committee.

[00:45:07]They'll agree with us.

[00:45:08]>> No, you're probably right. But we don't have that kind of time. I got to go tell those parents their 18-year-old son is brain dead.

[00:45:15]>> You want me to come with you?

[00:45:16]>> Nope. It's okay.

[00:45:17]>> What are you going to say?

[00:45:18]>> I'm going to say that it's likely, but we still need to do an apnea test and a cerebral profusion study. 30 bucks right now.

[00:45:25]>> There's no cranial nerve activity.

[00:45:27]>> Those people need some hope.

[00:45:28]>> False hope.

[00:45:30]>> Hope is hope.

[00:45:31]>> Is it? What are we praying for miracles today?

[00:45:36]>> They need time to process before they can accept what's happening.

[00:45:41]>> You ever consider taking that advice?

[00:45:44]Physician heal thyself.

[00:45:47]>> Don't you have patience?

[00:45:50]>> Um yeah. So the technique that he's using is what we might refer to as stalling. You know, he is trying to give them a little bit more time, but also show demonstrate that they're doing everything they can to be sure cuz the first stage of of grief often is that denial, right? So like it can't be true.

[00:46:08]He could have been saved. Why didn't you do this? Why didn't you do that? How do you know he's actually brain dead? So this gives a little bit more uh kind of armor against that.

[00:46:39]No, no, no, no, no, no, no, no, no.

[00:46:41]People wake up from coma. You can wake them up. You can do that. You can you can you can shock. You can sh that denial I was talking about.

[00:46:54]>> Totally reasonable.

[00:47:18]He's just giving them space, you know.

[00:47:20]And then this is showing kind of the vignettes of people hearing and reacting throughout the hospital. It's appropriate to give her space, not try to overexlain in that moment, not try to, you know, um, stop her in any way.

[00:47:35]It can you [ __ ] imagine, right? Like, yeah, she deserves that space to whail.

[00:47:46]No paricardial eusion, no tension, no pneumothorax, no cardiac activity.

[00:47:51]>> Let's try calcium. Could be hypoglymia.

[00:47:54]>> No, his potassium was normal. You ready to call this?

[00:47:57]>> Not yet. Dr. Robbie said three rounds of EP. It's time. Let's push another amp.

[00:48:02]This one could do it.

[00:48:18]such a good show. Um, a lot of interesting themes there, you know, continuing on with the rights of this Alzheimer's patient. Um, still, you know, MIA with the son who ran away. Um, you know, a lot of important moments of communication. So yeah, we'll continue on with this. And if there's any particular issue that you would like me to do a deep dive in outside of reaction, please let me know in the comments. But uh until next time, see youa.