that I'm trying to make you be--

- What is happening right now?

I think it's a beautiful day to save lives, don't you agree?

(squeals)

- I'm gonna like being married.

It's the wedding part that's ridiculous.

(laughing)

(pager beeping)

(groans)

Party's over.

- You know what's funny?

Even though this show was filmed so long ago, this scene

of them hanging around and having pagers still rings true.

All my residents still carry their beepers around

and they get paged, and they have to interrupt what

they're doing to go respond to an emergency.

Now, we're not surgical residents,

we're family medicine residents,

but equally as important, just on different terms.

- You marrying Burke, it's a sign.

A sign that people like you and me can do this.

Be healthy, be happy.

- Did she just steal my line in the show?

- They found the fourth climber.

Vitals are stabilizing after fluids, but--

- I thought he was dead.

- He was, according to his friends.

Did the CT show him bleeding?

- We haven't done a CT yet.

- I don't understand.

You said there was a head trauma.

- Yeah, there's been a little head trauma.

Ice axe to the head.

- Whoa.

So you really need, probably, a neurosurgery consult

at this point for having an ice pick stuck

in this gentleman's head.

Now, as I told you earlier on this channel,

if you ever get hit with something

and it stays inserted into you,

a knife, an ice pick, whatever it is,

you don't take it out because it's putting pressure on there

to prevent you from bleeding out.

So, if you take that ice pick out, what's gonna happen?

The person's gonna bleed, especially from the skull.

If you ever needed to get staples placed in your scalp

because you cut yourself, you know how much it bleeds.

Even the smallest little cut on the scalp

bleeds a tremendous amount.

It's actually really scary.

But it's only because there's a lot

of blood supply to that area, not because

there's a lot of damage to that area.

So just keep that in mind.

- My wife came into my hospital

and you neglected to tell me?

- Doctor-patient confidentiality.

- It's actually a very difficult place to find yourself

because, if you have one of your colleagues, family members

as your patient, you want to share and you feel

like you should be able to share, but in reality, you can't.

I actually treat a lot of my colleagues, even my attendings,

when I was a resident, their children.

And as a result, the things that their children tell me,

I can't share with them.

Only when they're brought into the room by the patient

or the patient expressed the fact

that I can discuss their case with them,

do I then incorporate them into the conversation.

But in reality, it's two separate people.

Just because I know both of you doesn't mean

I can freely talk about your care to one another.

There's some things we share with our family,

some things we don't, and that's a right.

- She's unconscious.

There are medical decisions to be made!

Legally, I have the right to know!

I have a right!

- She might be having a miscarriage.

- What's wrong with me?

- I'm going to explain everything to you, I promise.

But right now, we need to get you up to the surgical floor.

- [Patient] Surgery?

What about my babies?

- Well, I think those babies are coming out today.

- But, I haven't decided.

I haven't chosen parents.

I need time to decide.

- It looked like he was doing an ultrasound of her heart,

which is an echocardiogram.

I didn't follow the case from the previous story,

but it sounds like she's pregnant

and she's acting as a surrogate to give the child

to one of the two families there.

I wonder what could be going on with her heart

that they need to take her for an operation?

The medical curiosity in me is a-peaking!

- How's Rena?

- I need to get a CT adrenal,

but I'm pretty sure it's a tear in her aorta.

Her heart is about to blow.

- Whoa!

So, dissecting an aortic aneurysm is when there's

an aneurysm within the aorta, which is the largest

blood vessel that comes off of the heart

and brings blood to the rest of your body.

An aneurysm, first of all, is a weakness in the wall

where it actually protrudes out.

So, if you imagine your artery being like a balloon,

and then one area of the balloon is very weak,

so it creates almost like an outpouching.

When that happens, that wall's very susceptible to bursting

and rupturing because it doesn't have all the layers

that the rest of the artery has.

So, what can happen is you can have a dissecting

aortic aneurysm, where it's getting so bad

that that weak arterial wall is literally about to burst,

and that patient can rightfully bleed out and die

because of all the bleeding internally.

So you have to go for surgery immediately.

I just don't know how this is happening in such a calm

situation because it's really a medical emergency

or a surgical emergency where you need

to go, go, go, and start the operation.

- I didn't page you.

Go home and get some sleep.

- Yeah, but I'm here already, so--

- You're getting married in less than 12 hours.

- (music drowns out speaker)

- Well, Burke's getting married too, and he gets to operate.

- There's only one Preston Burke.

- There's only one Christina Yang.

- I've given you the day off, the whole day.

It's a kindness, take it.

It's your wedding day.

There will always be more surgeries.

- But--

- Really, what would you rather be doing?

Prepping a patient or prepping for your wedding?

Go home.

- Those who love our jobs and who are passionate

about our jobs, we want to be there.

But, at times, we have to pump the brakes

and realize that, if we want to perform better at work,

it's actually ideal to take some time off.

This is why one of the biggest problems that people face

is that as they make more money, you would think

they would become more financially independent,

therefore take more time off, but in reality,

they just become slaves to their money and to their job.

It's really important to not burn out

because too many people in our society right now are

working day in and day out, and there's times

we need to do that and we need to put our foot down,

but then there's also times where we need to understand that

a break will actually yield better results.

- They recovered Lonnie's body?

- Not his body, he's alive.

So why don't you tell me what really happened

up there with the mountain?

- So, I'm assuming, because I don't know a lot

about this case, they're on a mountain,

they were trapped, there's frostbite happening.

Frostbite generally happens on areas that have

less circulation, and areas that not only have

less circulation, but are ones that your body

will decrease blood flow to in order to conserve warmth.

So, for example, if you ever see your hands get blue

when you're really cold, that's your body

naturally protecting yourself from losing heat.

What it does is redirects the blood back to your core

so that you stay warm, your vital organs stay well profuse

with blood flow, and you don't need a lot of blood flow

to keep your hands alive.

So, if they look blue, that's what's happening.

There's also a condition called Raynaud's Phenomenon.

You have an ultrasensitive reaction to cold.

So, just being in a cold location for a short period of time

will make your hands turn blue.

A simple test for that is to put your hand in cold water,

and I'm not recommending you do this,

but you could put your hand in cold water

and take it right out.

If your hand turns blue really quickly,

you have what's known as Raynaud's.

- It was an accident.

- I feel like it's not McDreamy's place

to make the decision on whether or not it was an accident.

In this scenario, if I have people talking about self-harm,

or I don't know what you would call this,

like an assault-type situation.

Even if you think it may be on accident or self-defense,

you have to get the authorities involved.

I think that's the ideal situation.

Maybe not right in this moment because no one's

escaping here, they all look really injured,

but at some point, you have to get the authorities involved.

- So, should I be worried or something?

- Should you be worried that I met a woman?

No.

Should you worried that, for me,

flirting with that woman was the highlight of my week?

Yeah, you should be worried or something.

- (laughs) What kind of threat was that?

That's manipulative, McDreamy.

Don't do that.

- I just checked, Chief Resident hasn't been posted yet.

- No, no, I wasn't looking for--

- Yeah, you were.

- (laughs) Yeah okay, I was.

- For those of you who don't know, Chief Resident

is a really important position.

Even more important when you're a surgical resident.

I'll give you an example.

In family medicine, the senior attendings all sit together

on a committee and nominate

who's going to be the Chief Resident.

Generally, the way it works is the Chief Resident,

in their last year of residency, takes on the additional

role of doing all the scheduling, all the organizing

of the rest of the junior residents.

In internal medicine, they may actually stay on

for a fourth additional year.

To do that, consult on difficult cases, work in specialties

that they feel they need more help in,

or they use it as an opportunity to showcase themselves

for fellowship positions that they may have not gotten

or to make themselves more competitive

in the upcoming match.

Very prestigious, but very difficult to be successful in.

- Housing a human for nine long months

is all that I can think about.

The thoughts are invading the surgeries that I love,

and it's hormonal and horrible, but it is happening to me.

- You want to have a baby.

- (laughs) Did one resident just ask another resident

to impregnate her because she wants a baby?

I hope I'm missing something and they're actually

in a long-term relationship, and that was their way

of talking about it.

- Pressure's dropped to 60.

She's bringing it down.

Edison, how much longer?

- Rupturing the membrane now.

I just need two minutes to get these babies out.

- Make it one.

She's flat-lined.

Stephen, start compressions.

- Yay, they're starting chest compressions

before shocking the patient first!