Shiloh County Medical Center - Emergency Department

[T. Murdoch]

*I head into Resus 1, lining the stretcher up with the hospital bed.*

'What's the story?'

*Billy Ray and the nurse get the patient transferred over as I step aside to talk to the doc. They can get the patient moved. I have to talk to the doctor. I'm important, this guy looks important. And looks like he takes great care of his hair.*

'89 year old female, dialysis patient. Hasn't been to dialysis in around a week. No damn DNR, of course. Call came in as a med alarm with heavy breathing heard on the line. We made entry and found her unresponsive and apneic. She was in PEA with strong sine waves showing. We've done three rounds of ACLS, started a calcium drip, gave bicarb, and have now started her on dope. She's in a sinus brady, still has some sine wave activity, and her pressure is shit. 50s over 30s. And as you can see, she is intubated.'

*I get the doc to sign off on my chart and stand at the door for a few minutes, watching the nurses.*

[Dr. C. Grant]

*I listen and hear the story*
Man, what is it with people not wanting to go to dialysis today? This is our second hyperK of the day.

As soon as the patient is transferred over, I give her a good look over. Obviously, intubated with good chest raise, doesn’t appear grossly edematous, skin is ashen, and overall she looks awful. I take a listen to the lungs, then the epigastrium. The tube appears to be in place.

*I place the stethoscope around my neck*

looking at her eyes, I can tell they’re fixed.

'OK, let's get an ECG, someone call respiratory, let's draw labs. CBC, BMP, CMP, troponin.'

*I take a step back to let the resident in so he can do his physical. I look at the monitor, sine wave, rate of 49-50*

‘Let’s get a chest X-ray as well’ I say to Dr. Thompson. ‘Remember, all cardiacs get one, especially post arrest. It’ll also give us proof of proper intubation.’ 

’What dose of dopamine do we have running?’ I ask out loud.

’...and what was the deal with family? Is someone here or not?’ I ask looking over to EMS.

‘Let’s get a glucose as well. How do you want to treat her Dr. Thompson?’

 

[B.R. Jackson]

‘ they shoulda been behind us doc, swear i saw em in the side mirrors’ * i say as i finish wiping our strecher down outside the room* ‘ think they were gonna grab grannys stuff then comeup ‘

[Dr. J. Thompson]

*I step up to the patient, doing a quick physical exam. Even though Dr. Grant just did, I listen to the lungs and over the epigastrum.*

'15 mikes per kilo per minute.'

*I nod.*

'Well, Dr. Grant, I think the medic did a good job with the bicarb and starting the calcium drip. This patient ultimately needs dialysis, that's the definitive treatment here. As far as pharmacological interventions, I think we should give insulin with glucose and lasix. See if we can get the potassium shifted intracellular instead of extracellular and urinate out what doesn't shift. She'll still need dialysis, of course, but hopefully we can get a good head on this.'

[T. Murdoch]

’What dose of dopamine do we have running?’ I ask out loud.

’...and what was the deal with family? Is someone here or not?’

'15 mikes per kilo per minute. Family was on scene and knew we were coming here, I'm sure they'll be behind us so they can see their potato grandma get plugged into a vent and life support. Anything else you need, docs?'

*I glance over to Billy Ray.*

'Make sure that Lucas and stretcher get wiped down good. I don't want grandma juice on the equipment.'

[B.R. Jackson]

‘ you and me both’ i say to tom as i grab yet more disinfectant outta a supply closet spray it on the gear generously and further wipe our shit down* ‘ there grannys alive i dont think they will care what they plug her into’

[T. Murdoch]

'I mean, she has a pulse, sure. She's 89 and a dialysis patient. She'll be a potato for the rest of her "life". There's no soul left in that body.' *I put air quotes around life and step out of the room, standing at the ER desk and starting to put patient demographics into the toughbook. It wasn't right. Eighty-nine years, in poor health. Had truthfully probably been down a little too long. Resus'ing her was useless. She wasn't coming back. Not even if there was a pulse in that body. Grandma Jane was gone, even if her body wasn't.*

[B.R. Jackson]

‘ they dont needa know that yet but thats not our problem’ i gesture to the er doors following tom as i see the brother and karen enter  and a staff member stopping them* ‘ im good to roll when you are partner’ * i lean in whispering* ‘ preferably before the tear factory of the family starts’

Edited February 27, 2020 by Vanguard

[Dr. C. Grant]

‘I think we should give insulin with glucose and lasix.‘

‘Good, except nix the lasix, it won’t work in someone with severe renal failure.’

”Let’s up the dopamine to 20 mikes per kig.” I shout to the room.

*The monitor alarm goes off*
”She’s in VFib” someone shouts. “I lost a pulse”

”Let’s get her on our pads, and start CPR” I say as someone starts compressions.

*Pads are connected and charging to 200J*

”Okay. Stop CPR, let’s go ahead and shock.”

*CLEAR.The patient jerks as the shock is delivered.

CPR is resumed. Monitor shows asystole.
At that moment a clerk ushers the family to the doorway of the trauma bay. 

‘Dr. Grant, the patient’s family’ she says to me.

’Dr. Thompson continue the code please’ I say as I go to talk to the family standing in the corner of the room.

’Hey there. I’m Dr Grant, the supervising doctor, what’s your relation with her?’ I ask.

’I’m her daughter’, the woman states, ‘and this is my husband.’ she replies.

’So what do you know about what’s going on?’ I ask, half paying attention to them, and half monitoring what’s going on in the room.

’Well, we were notified earlier by her alarm medallion company that she had activated her help alarm, so we went over to her house and met the paramedics there where they found her on the floor.’ she explains.

’When was the last time you saw her normal?’ I ask.

’Last night. We went to visit her and check up on her since she lives alone...she’s so stubborn.’ 
 

‘Did everything seem okay last night? Did she complain of anything?’ I ask.

’No. Other than that she didn’t feel well. She said she felt sick like she was coming down with something. We told her she needed to go to dialysis, but she’s been refusing.’

’Why?’ I ask.

’I don’t know. She’s just so stubborn. She hasn’t gone in 2 weeks.’

’Does your mother have an advanced directive or anything tell us her wishes regarding if she wants to have CPR and stuff done?’

’Ummmm’, she pauses and looks at her husband. ‘I don’t think so.’

’Nothing at all that states whether she wants to be resuscitated or be on a ventilator or anything?’ I ask to make sure.

’...We’ll she has a DNR, but that’s only saying she doesn’t want to be on life support.’ the man states.

She has a DNR?

‘Do you have this DNR with you?’ I ask as I look back into the room to make sure Thompson is running things appropriately.

’Yeah it’s somewhere in here.’ He says holding up a huge Manila envelope with the words ”Health Records” written on it.

’Sheryl can you help me find a DNR in here’ I ask one of the nurses as I hand her half the stack of papers.

I thumb through records. Mostly junk from years of doctor visits.

’Here’ the nurse says handing me a piece of paper. It’s a POLST, signed and dated 1 month ago. Clearly indicated are: Do Not Resuscitate, No CPR, No Intubation.

’Okay. So this DNR indicates that she doesn’t want to be resuscitated. It’s indicated here she doesn’t want CPR, or to have a breathing tube in.’ I explain to the family.

’Why did you not give this to the paramedics?’ I ask.

’Well...no one really asked about the DNR, and I thought it was for life support and stuff like that.’ the man explains.

’No one asked you about it?’ I ask in disbelief.

The paramedics said she had no DNR...

’No’ He replies.

’This document states her wishes to not have us do anything heroic like CPR, give drugs, or put a breathing tube in. According to this she wanted let nature take its course if her heart ever stopped. This was signed by her, her doctor, and is pretty recent.’ I explain again.

’Oh my God. She had mentioned she just wanted to let whatever happens to her happen, but I didn’t think she was serious.’ I daughter says teary eyed.

’Unfortunately, this is her written desire and we’re going to have to stop our efforts since it’s against what’s written here.’ I say somberly.

’I mean, what are your thoughts on that?’ I ask.

The woman breaks down and falls into her husbands arms. I give her a few seconds, and she looks at me: ‘I just don’t want her to suffer anymore. I just want to do what she wanted.’ she says with a face full of tears.

’Okay.’ I say somberly

*I turn around and walk over to Thompson.*

’She has a DNR. Let’s call it.’ I say as I see she’s still in asystole.

’She has a DNR. She has a DNR’ I explain quietly several times to those in the room.

”Ok, go ahead and let’s stop CPR. Can we confirm no pulse?” I ask.

The room remains silent. Two nurses are checking for a pulse. They shake their heads.

”Time of death 15:23” I say aloud.

*I turn back to the family, and lightly place my hand on the woman’s back who’s tearfully looking on as everyone cleans up and turns off the equipment.*

’Is there anything you need?’ I ask softly.

’No. Thank you. ‘ she replies sniffling.

’We’ll give you a few minutes alone if you wish.’

’Thank you.’ the man replies, fighting back his own tears. 
 

*Everyone slowly starts to leave the room to give the family some time to grieve.*

I see the paramedic standing by the nurses station with his EMT having just finished making up the cot. 
 

‘Turns out she had a DNR the whole time. The family had it. Could have saved yourself a whole lot of trouble if you’d just asked about it.’ I say as I pass them and sit back at my computer.

Edited February 28, 2020 by Chris07

[Dr. J. Thompson]

‘Good, except nix the lasix, it won’t work in someone with severe renal failure.’

*Damn. Of course. I should have remembered that. Lasix is a diuretic. If you can't make urine, you can't pass it.*

'Right. I should have remembered that.'

”Let’s up the dopamine to 20 mikes per kig.” I shout to the room.

*I watch a nurse connect the dopamine drip to an IV pump and set the dose at 20, upping it from the medic's dose. I look up as the monitor starts alarming, and someone says that they've lost a pulse. I quickly identify the rhythm as vfib, nodding.*

”Let’s get her on our pads, and start CPR”

*Pads are connected and charging to 200J*

”Okay. Stop CPR, let’s go ahead and shock.”

*I watch as a nurse jumps to the patient's chest, starting CPR as I charge the monitor to 200 joules.*

'Clear!' *I call out, looking around the patient to verify that the team is clear. I press the shock button and the patient jerks. The nurse quickly jumps back on the chest, and I frown as the monitor now shows asystole. Damn. Shocked her out of vfib, alright, but right into the worst rhythm.*

’Dr. Thompson continue the code please’

*I nod.*

'Alright, let's get an amp of epi in the patient. Continue CPR. RT, you getting good compliance with bagging?'

*I supervise the code, folding my arms and watching. CPR was going well, the tube was still in place. The amp of epi was now on board. I look up to Dr. Grant as he walks back up.*

’She has a DNR. Let’s call it.’ I say as I see she’s still in asystole.

’She has a DNR. She has a DNR’ I explain quietly several times to those in the room.

*I sigh and nod as Dr. Grant calls for termination of resuscitation and then calls time of death. I take my gloves off, tossing them into the trash as I leave the room.*

[T. Murdoch]

‘Turns out she had a DNR the whole time. The family had it. Could have saved yourself a whole lot of trouble if you’d just asked about it.’

'She had a fuckin DNR?' *I growl, looking up from my paperwork. I immediately round on Billy Ray, fixating him with my stare.*

'Billy Ray! Did you not ask about a goddamned DNR when you got her fucking history?! Come on, get your fuckin ass outside so the family can have some privacy and doesn't have to listen to me crawl your ass for 20 minutes.'

*I stalk out of the ER and toss the toughbook in the passenger seat. Grabbing my cigs, I walk to the smoking area and wave for Billy Ray to follow me. I light up and start burning the cigarette down quickly.*

'Billy Ray. What the fuck, man? You didn't ask about a goddamned DNR? That's the most important fucking thing in a code. If she's got a fucking DNR, we can fucking stop. Fuck man, do better next time.'

*I look at Billy Ray in disgust as I flick the butt of the finished cigarette away and walk back to the truck, getting in and typing up my report.*

Edited February 28, 2020 by estone

[B.R. Jackson]

 * i follow tom out and hes pissed at me the second he gives me a reprieve i respond as i lean against the rig*.  ‘ i did ask they never answered the daughter mumbled something then broke down into tears her husband or whoever wasent there at the time i asked all she did was scribble the med list i gave you’

Edited February 28, 2020 by Vanguard

[Dr. J. Thompson]

*I give the family around ten minutes of privacy before I walk back to the room, quietly knocking. I slip in after hearing a faint 'Come in.' I offer a box of tissues I had snagged from supply to the grieving daughter.*

'I thought you might want these,' *I say softly.* 'Is there anyone we can call for you? A spiritual leader, or a counselor? The hospital chaplain is on his way down, but I know all too well that it isn't the same as your congregational leader being here.'

*The daughter looks up at me gratefully and nods as her husband steps up.*

'Is there a phone I can use? I'll call Father Moretti.'

'Of course.' *I take the hospital phone out of my pocket and hand it to him.* 'Just dial 9 for outside numbers, and please get it back to me as soon as you're finished. Now, I know this is a difficult question, and one you may or may not be prepared for, but do you know which funeral home you'd like to use? The coroner will ask when we make the phone call to notify him here momentarily.'

*The daughter takes a tissue from the box, blowing her nose. She thinks for a moment before speaking again.*

'Sympath Peace Arrangements. I've heard good things about her.'

'Yes ma'am, we'll let the coroner know, and he'll contact them. Now, I'll be right outside at the desk if you need anything at all. I'm Doctor Thompson, by the way.'

*I exit the room and head back to my seat, making sure someone notifies the coroner. He'll notify the funeral home, and hopefully we can get this body out of the ER quickly.*

Edited February 28, 2020 by estone

[B. Hunn]

"DID ANYONE GET THE PATIENT'S NAME, DATE OF BIRTH, ADDRESS, AND SOCIAL SECURITY NUMBER? WE CAN'T TREAT THEM UNTIL I HAVE THIS INFORMATION." I say. I am the glue that holds the construction paper together. I am patient registration. 

[C. Conway]

*Walking up as I finish eating my bologna sandwich wishing I had my protein shake to wash it down with.  I notice that the patient is dead.  Oh no, if only I wasn't on break I could have saved her and nursed her back to health with my sweet guns of mine.  Why must the good die old.  Tragically I walk back to the nurses station.*

[Dr. J. Thompson]

*I look up as I hear the funeral home come rolling in. They were new in town or something, and I had never had them come into the ER before. I look over the undertaker and then get up, walking over to meet her.*

'Hi, I'm Doctor Thompson. You must be Ms. Sennheiser. I've heard a lot about your company.'

*I had already looked up the funeral home, admittedly being a little nosy. When I walked over, I had admittedly planned on hitting on the undertaker, but it didn't quite feel right to ask her to go get appletinis while standing outside the room with dead Grandma Jane in it.*

'The family is still with the patient. They're in Resus 1.' *I gesture to the room.*

[Dr. J. Thompson]

'What I have heard is positive,' *I smile softly.* 'I would just check quietly with the family. They've had some time now. And if they need more time, then honestly we should probably move the body to a more private location. We need the room.' *I glance towards the room, then back at the undertaker.* 'Is there anything else I can do for you, Miss Sennheiser?'

[Dr. C. Grant]

I'm sitting at a computer, a USB connected TV-remote shaped microphone in my hand.

'Attestation' I say into the microphone in a soft voice.

A line of text automatically appears at the bottom of the patient's medical record.

Attending Attestation: I hereby attest that I have seen and examined this patient and agree with the history of present illness, physical exam findings, assessment, and plan noted above except as noted below

I pull the microphone back up to my face:

'Patient is an otherwise healthy 49 year old female who presented today for a 1 day history of persistent upper back pain...'

The text populates into the record. As I continue my dictation, I look up and see Thompson has those Goo Goo eyes as he talks with the Undertaker. I look over at the ER patient board and see that a new patient in room North 12. My initials CG are listed under attending, the resident slot remains empty. Patient's been in the room for 45 minutes. We're starting to get slammed.

I overhear on of the fourth year residents next to me speak wit a third year. I eaves drop as I dictate my notes.

Third year: 'We got 2 in. A 30 year old female chest pain and a 79 year old male left arm and right leg weakness with back pain. Wanna pick up another?' 

Fourth year: 'I'm at 6 as it is, with 2 critical. No way.'

Third year: 'I'm at 5. I'll take the chest pain I guess.'

The fourth year looks at the board.

Fourth year: 'Thompson has one patient and one stiff, he can take the weakness one.'

The fourth year assigns the patient to Thompson. JT appears next to the patient's name.

The two residents return to dictating their notes. Neither one takes it upon themselves to inform the poor intern that they just signed him up for a case.

Edited March 2, 2020 by Chris07

[A. Dunne]

My hair swept up in a ponytail, I see on my tracker that I have a new patient to register. We're starting to fall behind and people get very grumpy if the patients aren't registered in a timely fashion. Sure, they can put in into the patient's chart by hand but without a MRN and a wristband that puts them into the system, it takes longer, and the staff get VERY angry when we get behind. Some of these nurses can be remarkably vindictive. I hug the wall with my chair, the hospital issue computer and peripherals secured to a desk that's secured to my chair.

I'm working the North and Resus sections of the ER today - Resus is probably the most difficult to do registration wise since most of the time we have to rely on EMS's demographics and on a really bad patient, that's hard on them. Sometimes we're lucky and able to get an ID. Front desk gets almost all of the walk ins. Mostly I just deal with patients who came in by EMS.

I'm lost in thought as I roll down the hallway towards North 12, where my tracker has the new patient at. I spend most of my time in the registration office, unless someone comes in by EMS. I stop outside the door and knock before I push open the door.

'Hi, my name is Aubrey and I'm from registration. Can I ask you some questions?'

The older gentleman on the bed grumbles and sits up some before wincing.

'Hello sir, I just need to get some information from you before the other staff comes in. Can I get your name?'
'WHAT DID YOU SAY YOUNG LADY'

Oh goodness. He seems to be hard of hearing. This will be fun. I lower the pitch in my voice, and speak louder. It's a small trick that Rory taught me and it seems to work pretty well.

'Sir, my name is Aubrey from registration. Can I have your name?'
'MY NAME IS PHILLIP CHARLES KEELY'

Well. At least he can hear me now. I think to myself as I continue down the form.

'Mr. Keely, what's your date of birth?'
'DECEMBER 30TH, 1940'
'Mr. Keely -
'SWEETHEART, CALL ME PHIL'

He interrupts me and it gives the computer a moment to auto populate. It seems he's a patient of one of our doctors regularly.

'Alright, Phil. Do you still live at 5643 Pompton Avenue?'
'YES MA'AM I DO.'
'And do you still have Medicare and Aetna?'
'YES MA'AM I DO'
'Do you have any advanced directive or living will?'
'NO MA'AM I DO NOT.'
'Do you still see Dr. Martinez?'
'NO MA'AM I SEE DR. YOUNG NOW.'
'And do you still use CVS as your pharmacy?'
'YES MA'AM'
'Alright Phil, I'm going to have you sign a couple things for me. The first one is consent for the hospital to treat you.'

I move the signature pad peripheral that's connected to my laptop over to the gentleman. He seems to be struggling some with his left arm so I maneuver my chair so that the free space for the pad on my table is on his right side and reposition it so the pad is sitting on the table. He takes the stylus and signs it, and I move on.

'This next one is for your HIPAA rights. It says that we won't share your information with anyone who isn't directly involved in your care or your insurance company.'

He signs again, and I continue once more.

'Alright, two more. This one says we aren't responsible for your belongings while you're here, and the next one is our non-discrimination policy which says we won't turn people away because of age, sex, religion, disability, race, or country of origin.'

After he finishes signing, I take the stylus back and set it back in its holder. I take one of the blank wristbands from the container full of them on my desk. It's slightly cramped, but I make it work. I wrap it around his wrist and secure it.

'Phil, I hope you feel better soon.'
'OH DON'T YOU WORRY ABOUT ME SWEETHEART. I'LL BE RIGHT AS RAIN SOON I'M SURE. BACK IN MY DAY WE HAD TO WORK THROUGH OUR BACK PAIN. I WAS A SCHOOL TEACHER, YOU KNOW. MY WIFE TOLD ME I HAD TO COME IN WHEN MY LEG STARTED ACTING STRANGE. SHE'S SUCH A SWEET LADY, MY ESTHER. SUCH A LOVELY SEAMSTRESS, SHE MAKES QUILTS TOO. BUT SHE'S SUCH A STUBBORN WOMAN AND WOULDN'T LEAVE ME ALONE UNTIL I CAME IN.'
'Well, Phil. It's good she got you to come in. I'll be back here in a sec to put a sticker on that wristband.'

I roll out the door after sending the sheet of labels to the printer. I head over to the nurses station where the printer is, and grab the sheet off, tucking it under the computer. I roll back into the room, adding the label to his band so he can be scanned in when the care team works on him.

'Phil, good luck to you.'

I head out of the room, changing the patient's status in the tracker to "REGISTERED".

[Dr. J. Thompson]

*I chuckle, smiling at the undertaker.*

'You know, you're not the first person to tell me that. Anyways, I need to attend to my other patients. Good meeting you, Miss Sennheiser.'

*I walk away from the resus room, heading back to my computer next to Dr. Grant. I look over the board, sighing when I see my initials next to a new patient. I didn't even know this patient was here.*

'Well it would be great to know that I had a new patient,' *I grumble. I read over the chart and glance over to Dr. Grant as I start putting orders in.*

'Geriatric male with general weakness. Cardiac workup and ECG, troponin, CMP, CBC, PT/INR, head CT, chest X-ray. Anything I missed?'

[Dr. C. Grant]

'...she denies trauma, loss of consciousness, and impaired vision at this time.' I say dictating my note.

*I pause*

'Well it would be great to know that I had a new patient'

'Welcome to internship. Talk to your seniors. They're the ones who did it.' I say as I continue dictating: '...CT head was negative to hemorrhage, masses, or lesions. Patient instructed to follow-up with neurology as soon as possible...'

'Geriatric male with general weakness. Cardiac workup and ECG, troponin, CMP, CBC, PT/INR, head CT, chest X-ray. Anything I missed?'

'I generally recommend seeing the patient before ordering a full battery of tests, especially for something as vague as weakness.' I say as I put my microphone down and proceed to clicking boxes in the patient medical record.

'I'll be in to see them in a moment.'

Edited March 5, 2020 by Chris07

[C. Aylward]

*Dialing the direct line to the nurses desk, I hear a almost-too-happy man answer the phone. He must be a resident or something. And a new one at that, no one is that happy at a hospital.*

'This is the ERT. We have two deputies following in an ambulance en route to you with a suspect in custody. The restrained suspect needs a clearance and will be giving the report, but we'll also need our two deputies cleared for return to service, if you can have someone waiting for them as well.'

'Sure thing. Any word on injuries?'

*I'm in no mood to deal with if this is sarcasm or pep. Not my problem.*

'Nothing too serious, they're both transporting themselves, but we still need them back in service ASAP.'

[A. Breslin]

*We arrive at County. we unload and the automatic doors open for us. The registration staff groans as we go in. This guy must be a regular. The older one of the two scurries away leaving the new one I've never before at the desk. I unlock the tablet and hand it to her.*

'Coming in for psych eval. Hes sedated now but were going to want to get him to a bed sooner then later since he fucked up a bunch of cops.'

[A. Dunne]

*Of course she'd leave me to deal with the unconscious dude. Of COURSE.* 

'We'll keep it moving quick then. I'll take down what info you have demographics wise, if you want to give the nurse a quick report, she'll get you an assignment. Any PD to sit with him or do we need to get security? Is he in custody, officially?'

*The paramedic hands me a tablet and I copy down his info quickly. Gregory Phillips, June 29, 1991. And look here, he's in our system. I double check the address against the one on the demographics sheet on the medic's run form. Definitely the same guy. I pull up his chart and whistle softly.*

'Apparently, he's a regular around here.'

*I print up labels and a face sheet, taking one of the labels and putting it on one of the wristbands I have. I hand the tablet, labels, and face sheet back to the medic, and roll over to the stretcher. I briskly secure the band around his wrist, and the nurse is finishing up with the medic. It's not seconds after I've finished that I hear the phone ring. I sigh and roll back over to the desk, picking up the phone.*

Quote

This is the ERT. We have two deputies following in an ambulance en route to you with a suspect in custody. The restrained suspect needs a clearance and will be giving the report, but we'll also need our two deputies cleared for return to service, if you can have someone waiting for them as well

'Sure thing. Any word on injuries?'

Quote

Nothing too serious, they're both transporting themselves, but we still need them back in service ASAP.

'I'll do what I can. I'll get them triaged in, just have them come through the EMS bay. I'll send them to fast track as soon as I get them in and they should be out quickly.'

[R. O'Reilly]

*I walk in the ambulance bay behind the EMS unit, knowing I probably had a solid bruise on my face and definitely a busted lip. I walk up just in time to hear the registration girl ask if he's in custody.*

'Yes, absolutely. He is still in our custody. I'll be with him until someone from the jail can get here to take over, or until he gets released. But I suspect that won't be soon.'