Knock Knock Eye: The Pitt: Is This the Most Realistic Medical Show Ever?
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Hello everybody, welcome to Knock Knock Eye with me, your host, Dr. Glockenfleck, and this is your one-stop shop for all things eyeball related and occasionally some non-eyeball related things. So I'm excited about today because one of my favorite things to talk about is emergency medicine eye stuff.

Uh, and there's so many topics. That's how I started these knock, knock. I episodes was, was talking about, um, uh, pants patients, you know, the, the emergencies that require me to put on my pants and come in to see the patient, which is not very often. Yeah. There's maybe six or seven of them. Uh, and so we're, we have a little bit, here's the agenda for today. Okay. First, uh,

Match day is right now we're in this really fun window for everybody where the people that have matched are waiting, just waiting. Like there's their name and the program they're attached to is out there. It exists, but they do not have access to it.

The reason, the main reason for that is because you have a lot of people that did not match and they are going through one of the most difficult challenges in their career, their early career, which is desperately trying to find a program that will accept them. And so that's a very hard, hard situation. In fact, I made a video about

in, in, in support of students who don't match, uh, you can look at my YouTube channel and find it. It's, um, uh, uh, the med student goes to therapy. It's all about a student who did not match and the words of support that I would give to those students. Uh, in short, it's, um, that, uh, this, it's just one bump in the road. And, um,

And there are lots of examples of people that have tried again and again and again and still make it. And a career in medicine is long. And if you are dedicated, which so many, we are all dedicated to this field, you know, you have to be dedicated to patient care, to medicine in order to go into this because it's not easy.

And if you don't match, you know, you're, we're just, we're, you're at the mercy of the algorithm. All right. And often it says nothing to do with your intelligence, your ability, your, your work ethic. And so don't let this one weird algorithm thing, driven thing, define who you are and who you can be as a physician. One step back.

And, uh, and you'll be stronger for it. And so anyway, go check out that video. Uh, I'm not, I think I, I, I made it maybe a year ago, maybe two years ago, but, um, uh, I still have people that, that come to me around match day or that email me and say how much it helped them. And I, I it's, which is awesome. And, um, and kind of the point of that video is to just give some support,

to people who are struggling amidst a lot of people who are celebrating. I can't imagine how hard that would be. So anyway, this is a weird week. It's a trying week. It's a week for also celebration. But it's also a little weird that you learn that you match on Monday and then you can't find out where until Friday.

And so I've made videos about that too. And so, but we do have, the reason I'm bringing this up, because I think I talked a little bit last week about the match as well, is that we do know some statistics. So let me just, just a couple of things that have jumped out here. And I found these over on Twitter. There are 805 unfilled family medicine spots this year.

which is higher than last year. There's also 144 unfilled pediatric spots, which is higher than last year. But the family medicine thing really just, 805 unfilled spots.

That's an extraordinary number. And the fact that it's just every year, it's like getting worse and worse. And honestly, you can go back and forth on what the reasons for this are. Contrary to what some family medicine attendings think, I don't think I am the cause of that. That is like...

One of the only negative feedback things I've gotten from a portrayal of a specialty is I've had some family medicine docs over the years that have emailed me and be like, you know, I wish you would stop portraying a family medicine physician as this underappreciated, underpaid, exhausted, disheveled person because it's turning students off from going into family medicine. To that criticism, I say,

No, because I'm not telling anybody anything they don't already know. It is not going to be a silly comedy video that's going to make someone not want to go into a specialty. People know what they're getting into with family medicine. People go into family medicine because they love family medicine. They want to take care of everybody from birth to old age, birth to death.

And the whole gamut of ages and diseases, and they wanted to be a part of the community. There's so many reasons to want to do primary care.

family medicine and pediatrics. And so maybe I'll give you this. Some of my videos might convince someone that they, they should do a certain specialty, but I don't think I'm going to maybe cardiothoracic surgery. That's the only one I've barely ever depicted that specialty. Uh, and I'd be fine with that, but I don't buy the family medicine thing because there it's, I portray family medicine as a sympathetic character and they, and it, that's the way it should be.

Because they are overworked and underappreciated. But honestly, I think with these unfilled family medicine spots, you can't look any further than...

Well, maybe even two things now, but the whole vaccine issue is one thing because obviously primary care, pediatrics, they're there. They are preventive health is a huge part of what they do. And so the all the attacks, all the misinformation, all the vaccine of hesitancy around established vaccines like polio.

Like MMR, come on. Honestly, that's probably within the past couple of years driving it a little bit, but also just compensation. I mean, we can say till we're blue in the face that you don't go into medicine for the money, but you do want to make a decent living as a physician because you're spending your entire 20s training to do this job.

You're behind your peers. You're behind your peers who have been working since they were 22 in their career, rising through the ranks, making more and more money. And not only are you starting your career basically at the age of like 30, 31, 32, but you also have multiple hundred thousand dollar loan bill to pay for. And so

The cost of education is rising every year. Tuition is rising every year. And the compensation for primary care is decreasing every year. Something's got to give. So you can't, it does not shock me at all to see these numbers of residency spots going unfilled because ultimately, yeah, people might love family medicine and want to go into family medicine, but man, it's getting harder and harder.

to look at that, that these fields and be like, man, look how little people appreciate what we do. Cause that's a hard job. You guys, excuse my, my, my cursing, but yeah,

honestly. And it's awful the way we deprioritize family medicine and prioritize surgical care, procedural care. I mean, I'm saying that as an ophthalmologist. Yeah, sure, that goes against my specialty interests, but I recognize how hard primary care physicians work and the

It's just you got to think that compensation is driving a lot of this. And so I don't know how to fix it. But man, it's hard to see. And we're feeling it in certain parts of ophthalmology too. Pediatric ophthalmology is like a crisis. There have only been meetings at conferences about what on earth are we going to do about pediatric ophthalmology? No one wants to go into pediatric ophthalmology.

And so I think just peds across the board, it's becoming more and more challenging. 805 unfilled family medicine spots, 144 unfilled pediatric spots, higher than last year. Man, that's hard. That does not bode well for just...

Rural communities who rely on family medicine, who rely on pediatrics. My rural medicine character is not an accident. There's a lot of truth to that character who's doing literally everything for that community. What happens when you can't train enough of them? Or you disincentivize going into that field so much that it doesn't become economically viable.

to go that route. So either pay them more, pay them what they're worth, or let's get some free med school going on because something's got to give you guys.

Something's got to give. All right. Let's see. Why don't we take a... Okay. I didn't finish telling you what the agenda was for today. So we've already talked about the match day stuff. Congrats to everybody. By the time you hear this episode, everybody's going to know where they're going and then gets to be the best part of fourth year of med school, that post-match pre-graduation. That's prime ophthalmology rotation.

area of med school guys that's that's when we start getting i'll never forget this and in residency as a resident you get the the orthopedic surgeon the med student who matched an orthopedic surgery who's like you know what i'm kind of i'd love to do an eye rotation it's like yeah okay buddy like you come in you know we'll talk for 30 minutes then you can go to the library slash home

slash Jim, whatever you want to do, Mr. Future orthopedic surgeon, who's never going to look at an eyeball for the rest of his career. No bones in the eye. I keep reminding people, but anyway, it's a fun, it's a fun couple of months for the fourth year med students and they've earned it. They've earned it. They've been working hard. They match. They're happy. They get to look for housing and, and just think about their future. So congrats to all of you. All right, let's take a quick break and then we're going to come back and talk

We'll talk the pit, the new show about emergency medicine, the pit, and then talk about emergency department eye procedures. Hey, Kristen. What's up? I've been grossing you out about these little guys, Demodex mites, for months now. Yes, you have. Thank you for that. Well, good news. I have more facts to share with you. Oh, great. Yeah. These mites have likely lived with us for millions of years. Mm-hmm.

Passed down through close contact, especially between moms and babies. That's very special. They're born. They live, crawl around and die on your eyelids and in your lash follicles. Lovely. The entire life cycle from egg to adult lasts about two to three weeks. That whole time, they live right there on your eyelid. That's making me itchy. Okay. It is fun to gross you out, but we do all have these. All right.

It's really common. It causes a disease when there's an overgrowth of these mites called Demodex blepharitis. It causes the eyelids to get red, itchy, irritated. You get this crustiness to the eyelids. But I have really good news. This is actually really good news. Okay. We have a prescription eye drop for this. Okay, that is good.

That does make me feel better. Visit MitesLoveLids for more information about demodex blepharitis and ways we can treat it. Again, that's M-I-T-E-S-L-O-V-E-L-I-D-S dot com to learn more. Save on Cox Internet when you add Cox Mobile and get fiber-powered internet at home and unbeatable 5G reliability on the go. So whether you're playing a game at home or attending one live,

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All right, let's talk about the pit. So I've heard so many things about the pit, some good and some not so good. Really, the not so good from medical professionals about the pit is just that it's too realistic.

It's too visceral. It just drums up too much like, oh, yeah, I've been in that exact situation. And I get it. Like, why would you want to do that in your job? And then you come home and you want to watch something entertaining, but it's just reminding you about your job. I don't know.

um and and that and i mentioned this on one of our the knock knock high episodes but uh i saw a really good description of this it's like you want to uh and apologies the person who who said this initially i don't remember who you are but the er was for like showing glorifying emergency medicine and and and people know you know attributed it to to to

convincing med students to go into emergency, like it boosted numbers of students choosing emergency medicine. The pit's kind of like the opposite. It shows the nitty gritty, the

the dirty underbelly of emergency medicine, the true nature of emergency medicine being the safety net of society and all the abuse that comes with it, all of the anger, the conflict,

the blood, the vomit, the feces, all the things. So it's just a very visceral portrayal of emergency medicine. Well, it's been on my list. I haven't gotten around to watching it yet, but just a couple of days ago, I was looking through the comments, again, on our YouTube channel, at Glockenfleckens. All right, all these episodes are up there. I always look at the comment section. At Joe Sarcero on the last most previous, most recent episode,

where I talked about the wildest eye surgery you've never heard of, which is using a tooth to make a keratoprosthesis, a corneal prosthesis.

Anyway, at Joe Sarcero said, you've probably already been told many times the last week's episode of The Pit featured a patient who had been hit in the eye with a baseball. Actually, Joe, this is the first time I'd heard about it. All the gory eyeball procedures were performed by ER docs with no sign of an ophthalmologist. Would appreciate your take. Well, that's all I have to hear. I got on. I haven't looked. I haven't watched any of the other episodes, but I did find that scene. And let me tell you,

I am excited. This is why I'm excited about this, about to talk to you. I'm going to tell you, I'm going to take you through that scene if you haven't seen it and talk about what went right, what went wrong. It's episode one or sorry, season one, episode 10. And this. All right. So the reason this is exciting to me is because usually and this is true for the show ER, which I grew up on. I loved ER.

The most you ever saw from an ophthalmologist or from eye stuff in general, you might see an eye chart. You definitely will see a piss-poor penlight exam checking the pupils. It's the worst pupil exam you've ever seen in your life.

And so I was pumped. I was so excited to see an actual eye problem start to finish. I was thrilled, thrilled to death. And so, of course, I came at it skeptically because I've never seen it done well. All right, so here's what happened. Patient comes in, baseball, line drive, like 100 miles per hour. It's a pitcher right to the eye, something I've seen numerous times.

The guy, the kid's got a big swollen eye and gets whisked back immediately through the pressure of his father. There's like a conflict with the front desk and the father about cutting the line. And then the kid shows a swollen eye and the front desk is like, oh, right away, please come back. I'm not sure how true that is. But anyway, makes for good television. And so anyway.

The kid's sitting there. Here's what happens. So first, the first time we see him back in a room in the emergency department, he's got a shield on. Love it. Absolutely. You put a shield on if you're concerned about an open globe, which a line drive directly to the eye, yes, you're concerned. Open.

open globe, a rupture is one of those things that can happen specifically at the limbus of the cornea and behind the extraocular muscles. Those are the two weakest points of the sclera. So if you're going to have a, a, an open globe from a blunt force trauma, it's probably going to be one of those two things. It hits the eye hard enough, the object that it increases the pressure to a tremendous degree that

popping open the eye, those are the two places you're likely to see that. Right at the limbus of the cornea, the edge of the cornea where the cornea meets the white part of the eye, the sclera, or behind the extracular muscles. So yeah, first thing you do if you're not sure, you put a shield on the eye. You don't want the kid rubbing his eye because you could rub what's inside the eye outside of the eye.

And then one thing they did, they gave four milligrams of morphine, four milligrams of Zofran. Great. Perfect. I love it. That's great. That's like in our list of things we do for a possible open globe. You want Zofran. The reason is because the last thing you need is for a patient with an open globe to start vomiting.

Because that pressure, that intrathoracic pressure extending up into the neck and into the face, they could extrude some of their intraocular contents. All right, then we get to vision testing.

They did a decent job with vision testing. They started with, you know, can you see anything? I think they did the hand waving. Can you see like hand motion? There was no hand motion. So then they checked for light perception and turns out the kid could only, and out of that eye could only see light perception. The problem is they didn't cover the good eye before checking light perception for the bad eye.

And so it's, it's really hard to, you got, you always check vision one eye at a time, cover one eye before you check. But just the fact that they had the right turn, like light perception, vision does never been done in media. That's great. I love it. So light, we've got light perception, vision.

And then the nurse asks the doctor there, do you want the portable slit lamp? All right, those exist. We have them in the eye clinic. I can guarantee you that does not exist in any emergency department in the entire world.

Those are expensive and they emergency department, they barely have functioning slit lamps. They're not going to have a portable slit lamp. If they're, let me know. If you know of an emergency department that has a portable, I will shout them out. I will shout them out the next episode. If you have a portable slit lamp in your emergency department, I will be incredibly impressed.

Regardless, it exists. It's a thing and it would be helpful in these types of situations. I would want to bring mine with me from clinic to see a patient like this, especially if they did not have a slit lamp, a regular slit lamp that the patient could get into in the emergency. So anyway, portable slit lamp. I don't know if we actually see them do it, but then they proudly, the resident or the intern, I'm not sure who it was, proudly diagnosis a grade four hyphema.

Okay, so we got a grade four hyphema. That is a classic thing that happens in serious blunt force trauma. A grade four hyphema basically is the anterior chamber is full of blood, 100%. Almost what we call an eight ball hyphema, which is where not only do you have the front of the eye full of blood, but it's deoxygenated blood, which means there's no circulation of aqueous humor

which means that it's even more severe. So there's one step beyond grade four. It's like an eight ball hyphema. So it's black. It does not look red anymore. It looks black inside the eye. Regardless, when you have a grade four hyphema, that much blood in the eye

patient's light perception vision you got to check the eye pressure and they were on it they're like we got to check the eye pressure let's check the eye pressure then we get a tonal pin sighting you guys a tonal pin an honest to god tone but now if this was an actually like accurate depiction of how this would work the uh the intern would be a um would uh be be

to tears trying to calibrate this thing. But, you know, we can't wait around for that. That might take 15, 20 minutes. So, no, they had it. They got it. Put the preparacane on the eye. Saw them do it. Also did a little fluorescein test as well. So what they did, and this is really smart, before the intern came

checked the pressure, the attending came in and checked to make sure there was no open globe or no obviously visible open globe. And he did that by putting fluorescein on the eye and you heard the words negative Seidel. I will say emergency physicians, they love their Seidel test. That's one of the things that you guys, you try to like impress us ophthalmologists with negative Seidel.

And it always does impress me. It's great. I love it. Like, good. You're doing this, Seidel. You know what Seidel is. That's just a way to look and see if there's a stream of aqueous fluid coming out of the eye, which would indicate an open globe. And you use fluorescein and a blue light, a cobalt blue light to determine that. So great. We are doing fantastic. The pit is killing it. All right. They get the tone open. They check it. Uh-oh. 58. It's 58.

They got a high pressure. Now here's where we kind of just a little bit go off the rails because you got to ask yourself, what is the reason for this 58? Now I was thinking in the moment as an ophthalmologist, I'm like, you got a grade four hyphema. You got all this blood in the front of the eye. It's going to be blocking the drainage system in the eye.

causing the pressure to rise. That gives you a 58. So what do you got to do? You got to get rid of the blood. You got to do what's called an anterior chamber washout. You go in with tiny instruments and a needle and you basically just go, you just, you wash out all that blood to try to get the pressure down.

which I think I've had to do one time. And it's not easy because a lot of times that blood is coagulated and so it's hard. You get a big clot. It's like a last resort type of thing. But with blunt trauma, another thing that it could also be is a retrobulbar hemorrhage. Now,

In this, in the Pitts world, you know, that's the diagnosis they made. There was a grade four high FEMA, high pressure, but they assumed it was a retrobulbar hemorrhage. Now, when we first see this kid, I would like, I was like, there's no proptosis. Like this, this, this is not, this is not a retrobulbar hemorrhage.

Then whenever they're prepping to do the lateral canthotomy, cantholysis, it's like a prosthetic, clearly. They did some fancy makeup work that made it look exactly like a retrobulbar hemorrhage would look. So I don't think they got the right diagnosis based on what the kid looked like when he came in. I think his high pressure would probably be just due to a...

just due to a grade four hyphema. But then when they showed the eye up close with all the makeup and everything, they did make it look very convincing for a retrobulbar hemorrhage, which would be there was chemosis, there was swelling of the conjunctiva, and there was also a very clear proptosis. So, okay, so let's just suspend a little bit of belief here and say, okay, yes, clearly in this situation, the canthotomy needed to be done.

All right. So I would say the best, and I haven't seen it very often, the best depiction of our lateral canthotomy, cantholysis I've ever seen. And this is important too, that the comment on my YouTube channel was there were no ophthalmologists involved here. Like how accurate is this? All of this would happen without an ophthalmologist because you guys, we are at home. And as I've already mentioned, my pants are not on.

Now, this is a pants patient. I am putting my pants on to coming in to see a patient, but the patient's got an eye pressure of 60 and he's light perception vision. You can't wait for me to get my ass in the emergency department. You have to do the lateral canthotomy and the inferior cantholysis. And it's hard to do because it's bloody. You can see it. They actually portray it very well. They put the lidocaine in, just a quick little dab of lidocaine, and then you make the first cut.

And then it's just bleeding everywhere. All right. That's what you're going to, that's what's going to happen. It's going to bleed everywhere. So you're going by feel and they make that point. Noah Wiley, good old John Carter, Dr. Carter makes the excellent point that it's, you go by feel. It's like guitar strings. You just feel that tendon and then you cut the tendon. And then the last thing that happens that we see is not accurate.

Because what happens, think about anatomically what's happening here with the retrobulbar hemorrhage. You've got blood behind the eye that's pushing the eye forward. And what's keeping the eye from just propelling itself further out of the orbit is the fact that you have the eyelids that are holding it back. And so the eyeball is getting squeezed between the blood behind it and the eyelids in front of it.

And that's what's causing the pressure to dramatically increase and cause blindness. So what you're doing is you got to cut off the lower eyelid, sometimes even the upper eyelid. You got to open up those lids to allow the eye to just relax forward. Except whenever they do this procedure on the pit, what do we see the eye do? The eye sinks back into the orbit. That's not what's going to happen. If there's a true retrobulbar hemorrhage,

you cut the eyelid off you do the lateral canthotomy the eye is going to relax forward because the blood again is pushing everything forward so the eye is going to actually come forward even more before finally as the blood resolves as the bleeding stops it's going to relax back eventually once the swelling goes away but you're going to see and then they check the pressure the pressure is 18.

Overall, I give it like a 90. I give it a solid 90 out of 100. They did phenomenal work with this. A few little ophthalmologist quibbles, but it's okay. I'm a reasonable person, you guys. I can suspend a little bit of that.

I'm not that much of a stickler on these things. So they did just a great job. Whoever they got consulting them, they did great work. I wish it was me. No one's ever asked me. I'm kind of hurt by this. No one's ever asked me to be a consultant for a medical TV show. I mean, have they seen my content? That's probably why they haven't done it. Anyway, let's take a break. I'll be right back.

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All right. I thought we could close this episode out with some other emergency department eye procedures that we do. All right. So we've already talked about lateral canthotomy. We don't need to talk about that one. That's like probably the big scary one. But occasionally we do do other things. So anterior chamber tap and inject.

So we will do this in the event of endophthalmitis or with high pressure. Actually, with endophthalmitis, that's an infection in the eye, including the back of the eye. So often we'll do a tap and inject, but in the vitreous for that. Sometimes we'll do a tap, an anterior chamber tap, if there's really high pressure and we need to acutely lower the pressure and eye drops aren't working.

In some places, you can do, well, really, you can't do a lateral, a laser peripheral iridotomy because the laser's not going to be in the emergency department. So the tap and inject, either in the front of the eye for high pressure or back of the eye for taking a piece of the vitreous fluid, sending it for gram stain and culture. And then also, if you have an infection, an endophthalmitis, you would inject, you take out the fluid, and then you inject intravitreous

intravitreal antibiotics. That's hard to say. So that's one procedure we'll do in the emergency department. We've done that a couple of times. Another one we'll do is called forced duction testing. This might really sound like the worst,

the way when I describe this. So if we're concerned that a patient has extraocular muscle entrapment, there's lots of extras, extra, extra, ophthalmology. There's a reason we use acronyms for everything, you guys. It just, it gets out of control. But anyway, if you're concerned about extraocular muscle entrapment, kind of like this kid in the pit, big blunt trauma,

hits the eye real hard, causes an orbital fracture, and then the muscle gets trapped in the orbital fracture, that can cause a lot of problems. We've talked about that. That's a pants patient. Extracting muscle entrapment is a pants patient. You got to relieve that traction. You got to get that muscle out of the fracture as quickly as possible because then you have pieces of the muscle that could kind of die off. But anyway, as part of a

the testing to figure out could there be extraocular muscle entrapment, you do what's called force-duction testing. So you numb up the eye real good. Sometimes you'll even put lidocaine underneath, like in the subconjunctival space. You'll just inject a little bit of lidocaine underneath that conjunctiva.

numb the eye up real good. Then you take two forceps and you physically, you pinch the conjunctiva and you pull the eye in all the different directions to make sure that that eye can move where it needs to move. Um,

Patients don't like this very much. A lot of times we'll do some sedation for this. Rarely patients can just tolerate this pretty well. It doesn't really bother them. Usually it's kind of like, whoa, whoa, whoa, whoa, what are you doing? What are you doing? Kind of thing. And we do everything we can to make patients comfortable. And it's not usually like a painful experience. It's just like a very strange feeling that someone's moving your eye for you.

And so we will move the eye using force ductions, using these forceps in all the different directions. And if we get like a hard stop, like, oh, I should be moving this eye more, you know, further up than I am. That's a sign that you could have extraocular muscle entrapment and you might need to go to surgery to relieve that. What else? Another procedure we can do, we can glue the cornea. I've done this once before in the emergency department for like a puncture wound.

on the cornea that was leaking. So it was technically an open globe, but just a small little puncture, like a nail or something. As opposed to, and usually it's like a, mostly a self-sealing wound. Sometimes you can just get those to close up and heal up just by gluing the opening, the puncture wound. And that would save the patient a lot of time, a trip to the operating room, because you can do this at the slit lamp.

And so I'd say it's not really common. Most of the time patients will get to the operating room for something like this, but in a resource-poor environment where you don't have access to an operating room in a timely manner, you can try just putting some cyanoacrylate glue right on the cornea to plug up that open globe.

Those are the big ones that come to mind. Obviously, there's like suturing. You could use suture eyelids, but emergency physicians do that a lot. Eyelids, sometimes they call us in for specific types of eyelid laceration, so we'll do that as well. Various boils and furuncles and styes and abscesses, all these things can be done as well. Skin stuff.

Uh, and, uh, and so that's, that's probably mostly covers what we do in the emergency department. Generally, we try not to do a whole lot of procedures down there because the eyes are very delicate thing and the ergonomics are real off. They're not, they're not very good. I, I don't know how emergency physicians do so many procedures in the emergency department because like,

anytime i have to suture something there like i feel like maybe i just don't take care enough to set myself up for good ergonomics because like my back i just like throw my back out it's just it's terrible like leaning over i'm tall and so it's hard to i don't know sometimes the patient's in a weird position and i all the respect in the world for for emergency physicians they have a hard job and i think the pit

probably sounds like it portrays them pretty well. Now I'd like to an extreme degree. So I don't think it's like wall to wall action. Hopefully it's not because that's hard to do for like 10 hours or however long their shifts are. But, um, anyway, uh,

Respect. Respect. And respect to the pit for giving me some good eyeball stuff to talk about. That's our episode. Thank you so much for listening. I'm your host, Will and Kristen. Will Flannery. She's not here. There's nobody here with me. Will Flannery, also known as Dr. Glock and Plekken. That's me. Thanks to my executive producers, Aaron Corny, Rob Goldman, and Shanti Brooke. Editor-engineers, Jason Partizan. Our music is by Omer Binzvi. Knock Knock High is a human content production. We'll see you next time. Bye. Knock Knock. Goodbye.

You've been caught, Dent.