Skyhealth 1 Northwest Center for a physician...
Tell me why you think it's a stroke.
871 to medic six. Assisting
a 74-year-old male, shortness of breath, down to two-word sentences.
All right. Let me get liver transplant on the line for you.
No relief from the nebulizer.
What's the address of the destination for the patient?
Is the patient ready to go now?
An admitting diagnosis whenever you're ready.
6 medic 99. That's a normal response for alpha site.
- 10-4. - Tell me what happened.
Is she awake?
Is she breathing?
Sky Health One Pilot. I have admission request.
Sky Health One Pilot, go.
I have a 53-year-old male patient.
Patient weight...
Six medic 40, I have a 27-year-old female
complaining of severe stomach pain, lower right side, possible appendicitis.
- Address, 85 Hoffman Avenue... - Copy.
Sky Health One Pilot, I have a mission request
coming out of Staten Island, North University Hospital.
Possible stroke victim going to Lenox Hill Hospital in Manhattan.
It's imperative that we move quickly.
Time is of the essence.
All right, I'm clear.
- Right, south liftoff. - All right. Ready.
All we know right now is that the patient is having complaints of potential stroke.
Not sure what kind yet.
Time is brain, you know, so we want to make sure that
we're doing all the right things for this person.
Complication in New York City
and Long Island, in general, is obviously traffic.
When time is of the essence,
we can go where the patient needs to go, that's having the worst day of their life.
I'm very decisive in those moments.
I know exactly what I want.
I know exactly what needs to be done.
Let's do this.
I think in stressful situations,
you just almost go into autopilot.
People don't need your tears.
They need you to be their nurse or their medic.
Hey, I'm MacKenzie.
I'm gonna be the flight nurse taking care of you in the back.
Just want to do a couple of tests on you.
Push up with both legs.
Good.
So, I just got a report from the nurse.
She sustained a fall. She's been aphasic the entire time.
That hasn't changed.
Possible MCA bleed.
- One, two, three. - Okay.
Gonna put a blood pressure cuff on your arm, okay?
We're gonna take good care of you, I promise.
120 over 78. She's good.
- Have a good one. - Have a good one.
We're gonna get you into Manhattan really quick at this time of day
'cause we're gonna fly over all that traffic.
Once we get to Manhattan, we're gonna take a quick ambulance ride to the hospital.
O2 stat dropped a little. Do you want to put her on a non-rebreather?
Yeah.
Is your pain doing any better?
Can you hear me right now?
She's a little less responsive than she was before.
- I'm coming out of my belt. - Alright.
How far out, then?
- Two minutes. - Okay.
All right, darling, we're gonna take good care of you, okay?
- Now. - Yep.
Three.
So, we have a 34-year-old female, and she fell.
She was not acting herself, she wasn't talking,
so we are concerned that she might be having a stroke.
Because of the way that she hit her head,
she may have a bleed.
We are gonna try to get her to Lenox Hill to get her further care.
6 Medic 99 Central. Do you have me en route to Lenox Hill Hospital?
6 Medic 99, you are 82 to Lennox Hill.
You know, if you've never been in the ambulance,
you don't know how important a minute is until you're back here.
It's very touching, and she's almost my age.
Things that go through my head, her family.
- You got a flush over there? - Yeah.
It's the first thing they tell you.
Don't get so involved,
because then when it's time to leave, it breaks your heart
because you wish you could do a little bit more.
All we can do is pray for her.
Hey, we have the transfer from Staten Island.
Okay, great.
Thirty-four-year-old female sustained a fall.
Was complaining of a headache. Worst headache of her life.
She's had a sudden onset of right-sided weakness.
Two, three. Okay.
Hi! Can you tell me your name?
Let's get her finger stick. Let's get her on the monitor.
You're in good hands.
You're gonna be okay.
Blood pressure is 109 over 69.
Lift this leg up.
- Very good. Nice shoes, by the way.
Squeeze my fingers. Squeeze tight. Good.
We're gonna get you back to CAT Scan.
We're going to take care of you. Sorry you're going through this.
Can you take off your mask?
Yeah. Is it okay like this?
- Yeah. - Okay.
My grandfather was a doctor in Cuba. He was a pediatrician.
I didn't grow up with him because he never left Cuba.
I grew up and was born and raised here in New York, in Queens.
I went to medical school thinking that I would probably do
like my grandfather and be a pediatrician, and then I fell in love with surgery.
I fell in love with the immediacy of helping someone with a problem,
and seeing it fixed right away.
I grew up ten blocks from here.
My mother still lives in the house I grew up in,
so the children I care for are not just anybody's children.
This is really home for me.
Helping to build the biggest, busiest, pediatric trauma center in New York City,
it matters to me.
Okay. Do the other side too, okay?
We're done, we're done.
My role is a pediatric transport nurse for the health system.
We're all trained in critical care and have ER/ICU background,
so a trauma comes in, we're all able to jump in and assist if needed.
All hands on deck when a trauma comes in.
Mom, Dad, we're giving some Benadryl. Might get a little sleepy.
Don't get concerned about that. I'll be right outside the room.
We'll be going over in a few minutes.
It's a great feeling to come in and make a difference,
'cause I have children in the area, and if something were to happen,
they'd end up here.
Transplants coming.
Alright, hold on one second.
Hi, it's Donald from Cohen's. Can I get the Peds ER, please?
This office is our pediatric call center.
We are one of the only pediatric critical care transport teams in the area.
Transport, Donald.
And as nurses, our physicians train us to a higher level.
Outside facilities call us as if we're 9-1-1,
and frequently it requires actual transport into our facility.
Transport, Donald.
He's a 17-year-old male coming in with two entrance wounds.
Probably two exit wounds.
Pierced the diaphragm, lacerated the liver,
as well as the stomach and spleen.
Ready to go!
Still actively bleeding.
We just got activated for a level one trauma.
A 17-year-old who was shot last night.
He was brought to the emergency department at another hospital of ours.
In the middle of the night, he actually tried to die three times.
We don't really have all the information at this point,
which is really common in a trauma kind of world.
We have to make decisions with imperfect information.
Hi, guys, how are you? Who's here from my team?
Good morning, Dr. Prince.
The key thing for the team
is this kid's been in an ICU setting all night.
So this needs to be efficient.
We really just want the CT/Angio.
We want to be quiet, efficient, and get him to the next step.
- Family is here too? - Mom is here.
Okay.
Good.
Okay, this is Joshua, a 17-year-old male.
He has multiple gunshot wounds.
He had a splenectomy.
They did repair lacerations of the liver, also gastrectomy times three.
One, two, three, ready.
Joshua, everything's okay. You're in the hospital.
Was there a penetrating injury to the neck?
- There was not. - Was there an assault as part of this?
Unclear of the history prior to--
The injuries are the humerus and belly.
Okay.
- If you happen to have an FFP. - Can we get him an FFP?
Alright, so somebody get the FFP, I'll give it.
Another. Get it.
Can I have another FFP?
Hi, I'm Dr. Prince.
Sorry you're meeting someone like me in the middle of the morning like this.
Right now, they're just calmly getting him from the stretcher
and all the transport stuff here,
and set up to our equipment so we can track everything.
And then we're gonna go next door to get another CAT scan.
We spoke to the surgeons that did the surgery there.
We're very up to speed with where things stand.
Just wanna make sure with the move in the ambulance,
there's a lot going on,
and get information so we can draw out the next step.
- Okay. - Um...
Do you have questions for me right off the bat? Or...
I'm just scared.
That's appropriate, ma'am.
I'm so sorry.
And that's appropriate, ma'am. You're allowed to be scared.
Look, you are not here alone.
There's everyone here.
All of us are here to help you with this,
and I know I was told there was a lot of family with you,
so we'll get them all in when the time is right.
And...
We'll walk you through this. We're here for you.
I'm sorry.
I'm not sure how much of this is just New York City, COVID,
but the world's changed.
COVID was like a real wake-up call,
but also a stressor that we still haven't fully recovered from.
One of the reasons we saw so many deaths early was hospitals were overwhelmed,
but people wouldn't come in until they were really sick
because they were afraid.
People that had moderate problems, or even major ones,
that were staying out of hospitals, suddenly reappeared,
that had been hibernating under the cover of COVID.
I'm just worried about the size of this clot.
She's young and she's healthy.
You know, I wouldn't want to wait on this. This is too big.
- What's her first name? - Julian. She wants a family.
Good morning.
- How you doing? - I'm doing well.
Good.
Hi, team.
So, this girl was at a wedding.
The left side of her face was weak, she's getting weakness of her arm.
She literally was having a stroke, comes in emergently.
She has a huge blood clot in the right hemisphere.
Can you lower your mask just to look at your face?
Smile for me.
It's consistent with what's called a cavernous malformation.
We confirmed that with follow-up study,
which showed that the amount of clot shrunk a little bit,
but you know, a 29-year-old girl with all her life ahead of her?
The last thing we want to do is take the risk of it bleeding again
and giving her a big deficit the rest of her life.
After seeing her improve,
and the thing is shrinking, let's get it out of her.
That's why we're doing this quickly as we can.
Most of our surgeries are "should and must,"
and that means that you have to have the operation in order to prevent
loss of life or limb.
One percent lidocaine with epi 1:100,000 was injected.
We have defibrillator in regular surgery center and surgery floor.
Let's rock.
So, this lady's 29.
She was at a wedding with her husband
who's an orthopedic surgery resident in North Shore.
She actually is an opera singer, of all things,
and a really sweet lady.
And her husband is a good guy too. So let's do a good job.
...in Times Square, as a shooter fires after a fight,
sending people scrambling for cover as--
This is our engagement party. We got married four months ago.
She's a classically trained opera singer.
She also auditions for Broadway.
This was like her first show.
She must have been on the phone with like 50 different people.
She was like, "I don't want to go to sleep,
and I don't know if I'll talk to these people again."
During the COVID pandemic, people delayed their healthcare.
That had significant consequences for everything,
from detection of cancer, to checking your blood pressure,
and that led to an increase in just about everything we see, including emergencies
and late diagnoses that should have been picked up earlier.
And even more importantly, people had been staying home.
Now people were going out in public.
Assaults went up, shootings all of a sudden went up.
There was frustration, there was fear,
and all these things basically resulted in human beings acting out again.
If we can get him scanned,
so we can get him in the ICU, it'll be a better place.
- Donald? - Yes?
- Are we on a portable monitor? - Not yet.
I'm checking the line first.
- Cover him up, please. - Airway, we're okay?
Mary Anne, we're okay to move?
Donald?
Okay, let's go.
He was at a party.
He was shot a few times,
and then he was taken by private vehicle to a small community hospital.
With the report that we received,
what I expected was someone to be completely comatose.
He had cardiac arrested three times,
and we were informed that he was actually brain-dead for all intents and purposes.
And that further leads to the shock when I arrived and started my rapid assessment,
he actually opened his eyes, and I saw fear in his face.
That's not something that you want in your patient, because fear
increases your oxygen demand, stress.
We need to be compliant with what we're providing
so they don't further injure themselves.
- Have we given a PRBC yet? - Just now.
- Do we have platelets? - We should give platelets now.
Keeping someone alive for 25 minutes in an outside ambulance,
in an unstable environment, is extremely difficult at best.
The platelets is the one unit they gave me...
- And we're giving it? Perfect! - We're giving it all.
Give another FFP next.
Thanks, Donald.
65 milligrams. Rock and rolling.
...here and we'll reattach as soon as we move over.
- I'm going to disconnect. - Okay...
Take this.
Everything's okay, Joshua. We're going to move you over.
And pull tight.
One, two, three.
Doing this job, as a parent, makes it more difficult for me.
I have a son that's 16 years old. That could have been my son hanging out.
We don't know what happens when people are out.
Egos start to blow and you don't think clearly,
and unfortunately, the families are left to hold the ball afterwards.
Are you an older brother or younger brother?
- Older brother. - Um...
I know you guys know there's a lot going on, okay?
I'm just going to try and get him over here next door,
and then we're going to figure out what we're getting you guys to the next step.
- Okay, you got your mom? Yeah. - Yeah.
So we just gave platelet. We're giving another FFP now.
It'll be our 4th FFP here. And the next one will be blood.
Guys, it's already coming down. 126. 119, guys.
He doesn't have a blood pressure right now.
Get him back on the pressers.
- How much, one gram? - Give me 10cc syringe.
If this becomes a code, will you run it for us? Okay.
It's so devastating.
A couple pieces of metal and you take a young person's life
and put them on the edge in two seconds.
Medic 99,
we have a suspected hit-and-run with bleeding shunt.
NYPD at location.
Suspecting assault. This is a code three. Over.
It's 57, female bleeding from the outside shunt.
When did this happen? What happened?
I'm not fighting nobody but you.
Everybody knows your ass disrespectful.
Why the fuck you talking about nobody saved your ass?
Don't go nowhere. Stay here. Tell them what happened.
- Hello. - ...fuck are ya talking about?
- What happened? - I saved...
Hold on one second. Let us take care of her, okay?
Sir, can you just give us a second?
We're just trying to help her, okay?
- What's your name, ma'am? - Vickie Williams.
Okay. Hi, Ms. Williams. Let's concentrate on you, okay?
Rob? PD for scene control, please.
Okay, so this young man in the green is your family member?
- Yeah. - Okay.
And who was the driver of this vehicle?
That guy right there.
- With a black hat on? - Yes.
He didn't put the strap over me.
Okay, you have any dizziness or pain?
- I hit my head. My head hurts. - Can you grip my hand?
Do you want to stay here or do you want to go to the hospital?
- Hospital... - No problem.
Okay, Miss Williams, my name is Vicky, okay?
We're going to take your blood pressure. On the left arm.
Your name is Vickie, and my name is Vicky. So, what we gonna do here?
- You lost a lot of blood here. - Go to Applebee's, have dinner?
Don't worry, we're gonna figure everything out, okay?
Thank you, Vicky.
Okay.
- That good? - Yeah, that's good.
One, two, three.
- You comfortable?
I'm not talking to you!
I am not talking to you!
- Sorry.
My ribs!
- Is that better? A little better? - My ribs!
- I'm sorry.
Oh, my ribs!
How can we help you with the pain?
Just put something here, then I can rest my arm.
- Okay. - You want us to move that?
When we start driving, your ribs are going to hit against this handle.
- So we're trying to pad you. - Yeah...
We're having you sit on the pillow.
That's what's leaning you to the left side.
Let's start rolling.
- Leo's a demon. I keep telling you that. - Is that your husband?
He's not my husband. I'm not married to him.
I'm just asking, I'm sorry.
I understand.
He's been in my life for 12 years.
- And 12 agony ass long years.
Okay, you want to say something before you leave?
- Something nice, okay?
Mooks, I'm right behind you.
I'll be right up there. You heard me?
Don't talk to me, Leo. You wrong.
- Why am I wrong? - Know how to get there?
She's mad at me because I didn't beat the goddamn driver's ass.
That's why she's mad?
He should've whooped his ass when he sees all the blood.
I'm about to bury my son Tuesday.
- I'm sorry to hear that. - He ain't protecting me!
What, you want my kids to protect your 78-year-old ass?
- Yeah, whatever.
We'll see you there, Leo, okay?
You ain't got no soul.
We're trying to keep her calm, so we'll see you there. Thank you.
"You gonna talk about a damn latch on the floor."
I said, "Sir, could you please get in the middle lane?"
"What the fuck's she scared of?"
- That's what he said to you? Oh no. - "What the fuck's she scared of?"
He gangster.
He Crip or he a Blood.
One of them. He got the tear.
You want to be heard and sound
and seen.
That's all that is. You want to be heard and seen.
That vein's gonna have to go.
Another vein underneath that, which is
entirely predictable.
You see this?
This is what he's splitting now with the knife,
and once he's down, spreads the frontal and temporal lobe,
you can, basically, doing this, spread this open.
We're going to get into it here.
This needs to come out.
On.
Veins everywhere.
On.
Wait till I say it, goddamn it. On.
The walls of a vein are much thinner than the walls of an artery,
so you can move an artery with more aggressiveness than a vein.
Scissor.
I'm gonna cut through this shit. Should be right in the damn thing.
No, you're not, you're a centimeter off.
I'm not. It should be right there. I don't get it.
- See yellow right there? - I see yellow everywhere.
Nav.
What the fuck? I mean, what is this?
- Could this be a fucking tumor? - Nav.
Oh yeah, it looks a little gray.
Rachel, can I come over? Step on the pedal for a second.
- The nav is right on it. - You're skiving off the front end.
It's so big I shouldn't hit it anywhere.
That's the thing. It's bleeding now.
Can I have the cortical stemmed electrode? I want to stimulate.
I think I see it.
I'm gonna stay away from that artery. That's it.
You guys see that?
It's too big to take out in one piece.
Bipolar?
On. There's the blood inside.
It's like popping a blood blister.
Turn the pipe up to 35. On.
- So much blood. - Give me a second.
It’s nonstop.
Look, it's still coming, John. Incredible.
Man, I've never seen it bleed this much. There's a lot of clot in there.
Can we get a bigger sucker, please?
They're just really good at grabbing shit.
Here it comes.
So what about this stuff right here coming out?
There it is.
Here's my finger to give you size.
We got it all in one fell swoop. I don't think anything's left.
- I think we're done, bro. - Yeah, I like it.
If you look at the size of this thing,
you can picture this though, just sitting in the middle of her brain.
And that's what ruptured. Looks perfect.
- That's great. - Lucky girl.
I mean, I think it was really what we needed to do,
and I appreciate your being here and doing this with me.
When there's an emergency, we work together
and support one another through that
because they can be remarkably emotional moments,
and very memorable times when these things go well or go poorly.
Call me.
Okay, uh...
- Miss Williams, are you okay? - Yeah.
I know you're tired, but I don't want you to sleep, okay?
In case you had a concussion from hitting your head.
So try to stay up. We're almost there.
Every call is a new story.
You encounter so many different situations, you know, people's lives.
When people say like, everybody's fighting a different battle.
Sometimes you wonder how the person got to be in this situation.
They call us because they feel like, for them, it's an emergency,
and even though we are used to seeing it every day,
I feel like it's very important that we never lose that touch,
to always care for them in those 30, 40 minutes that they're with us.
My goal is to always make them feel safe,
and let them know that they've been heard for what they need.
I'm gonna take a look at your arm again.
Very good. Put it down.
We're here.
- Thank you. - No problem.
It definitely makes you think in how much you need to be here,
a hundred percent body and mind,
to make that difference in somebody's day.
- Don, are you getting anything? - I'm getting nothing.
Give him a hundred. Crank it.
Put it to 100. There's no reason not to.
What's your heart rate now?
118 heart rate now.
Did you start norepi?
Blood pressure is under 90...
How's her pulse?
It's palpable. I can't tell you a rate.
Okay, let me know when you hear it.
It looks like blood pressure is approximately just under 140. Systolic.
140 systolic? So he responded to the norepi very well.
- Think so. - Great.
If we get a reasonable rate and reasonable pressure,
can we scan him?
I don't think he's bleeding from the stomach.
- There's no blush in the stomach. - Yeah, the chest looks good.
So there's no reason to open his chest if he arrests.
No, I don't see any reason to open his chest.
Alright, so we just got to get him to the ICU.
And Don's got push pen epi if we need it.
- Disconnect. Yep. - Okay.
- On your count. - Ready?
One, two, three.
I have the tube. And we're reconnected.
He got quite sick while we were doing this,
and we had to make a few adjustments, give him quite a bit of blood,
and give quite a bit of blood pressure medicines
and a mix of the two different things.
Uh...
And the whole time, it's kind of been a dance to see
if he loses his blood pressure or his heart goes into a bad rhythm
like happened last night, where he tries to go.
Um, I came looking for you.
The good news, at least for now, is that we don't see any bleeding
from a major artery or something like that,
or like the liver I was telling you about.
So what we want to do is get him upstairs to the ICU.
I don't think he needs an operation right now.
Okay...
The most acute problems are the ones where you realize
you can't change something terrible that has happened to a child
and maybe that moment of time where I know it,
but the parents still hope that it's not the case,
and that gap in time until you help to bring them
into the new reality that they're going to face.
This is going to be hour by hour for the afternoon,
see what happens, and then decide whether--
- But he's in the clear right now? - He's--
For right now, he's in the clear for this moment as far as doing surgery.
He's not clear big picture, which I know you're asking me.
Um...
We can-- Really for now, it's one hour at a time.
We want to get him up there safely,
keep him from having these major medical problems
where his heart is trying to not function.
And...
Um...
And then get through the night tonight again, right?
As a parent, you don't know what's going on,
you're not with them, and so there's sometimes this gap
where a lot has happened, but the parents don't know what has happened.
And I understand, really, what this means for how this child's life
will probably not be what anyone dreamed it would be.
As a young neurosurgeon, even as a medical student,
what attracts us to nurture this kind of urgent need to be needed.
You have to respect the fact that that commitment
to the life of another human being is something that we make,
and that we do, and that we live with that all the time.
- All done, Julianne. - So lucky, I know.
You don't even need that.
I spoke to your husband. Brandon knows everything's okay.
- Okay, show me your teeth. - Smile.
Give me a squeeze.
It's a little weaker, but it's normal.
Wiggle your toes.
Good.
Everything went perfect.
Should I let your husband know you're alive?
Okay.
All right, sweetie.
Aww.
Looks good.
- Went great. - Did it?
Yeah, no problems, everything's fine.
I'm as optimistic as I could be.
When you're up against her motor area and deep, you only have so much latitude.
You don't want to push the envelope too much.
I'd rather her be strong, normal,
have a little thing to follow than the other way.
And it's not cancer, so it's something we could always follow.
I think you'll have a long, happy life together.
- All right. - Thanks, buddy.
- Hang in there. - Thanks.
- All right. - Thank you.
- Take care. - You're awesome.
I got emotional with the guy.
She'll look great, I think.
She may have some deficit afterwards, actually.
I wouldn't be surprised.
We were really close.
Bring you up. You warm enough?
All right.
Hello.
Julianne, how are you?
- I'm fine. - Good.
Hello.
- What's wrong? - I'm so happy.
People deserve you.
People deserve someone that wants to give their best.
It was a good day.
Healthcare is going to be important for all of us.
This pandemic has proven that.
We proved that, you know, human beings still want to help.
Sirens are the soundtrack of the city.
And many of those sirens are people in need.
And all of a sudden, out of this morass...
when you need people and they're there.
The team is different every day.
Which nurses are here. Which surgeons are here.
The effort that's involved to really have the expertise here 24/7.
That's the magic that comes together to take care of children.
- That's my youngest child. - Yeah.
To watch him suffer,
it hurts that I can't physically
do anything to help him, to help his pain.
It hurts.
All the Pampers, all the years, all the tears,
and all of that work that, you know,
a whole family pours themselves into it.
And in a second... ...one bullet, and it's all gone.
He's a great big 17-year-old,
but my son has a 16th birthday in two days.
Inside, they're still little boys.
And I know for that mother, that's still her little boy.
I worry that as healthy and strong as he was coming into this,
the hit to his body is so huge that, um,
it's like he's an airplane that's about to crash.
He hasn't even leveled off at this point, and so that's the question.
Is he going to hit that ground before we can pull him out of it?