evening spirit

Okay, so, the vial of lorazepam, what do we know?

Santos was struggling to open up the vial while treating Joseph Marino

The first indicator to both Santos and the audience that something may be wrong with the vial is that she's struggling to get the cap off. However, when reporting to Dana she brings it up as a possible issue in manufacturing or transport. When Dana shuts down any concerns though, it's shown that the issue keeps nagging at her. Suspicion on Langdon doesn't really get brought up until later in the episode when she'd talking to Donnie.

A higher dose of medication was required to break Joseph Marino's seizure than is recommended in medical textbooks

Langdon orders to use more of the lorazepam than recommended, potentially risking an overdose. When Santos brings this up, he shrugs it off as "Sometimes they just need a little more." Is this true? I don't know. Again, not a medical expert. For all I know, the effectivity of these kinds of medication may vary with factors such as metabolism, age, body mass, body mass distribution, tolerance, age of the medication, manufacturing errors, etc. You know who does know this? Robby, who is in the room with them, whom Santos brings up the dosage issue with, and who backs Langdon's decision to administer additional lorazepam. If administering additional medication really was an insane call that could only be explained by Langdon making up for diluted medication, why did Robby not say anything about it?

There was glue on the inside of the cap of the lorazepam vial

Now, I've seen takes that assume that the purple glue was used by Langdon to reattach the cap after he diluted the vial, which I get, but it doesn't necessarily hold up to scrutiny. If the glue was out of place (and it's bright purple, it's not easy to overlook), why didn't Santos immediately become suspicious of it? Or Dana, for that matter? IDK how these kinds of vials are manufactured (people who do, please chime in) but based on what I've seen on screen it could just as well have been a low strength adhesive that is intended to fasten the cap to the vial while letting it be easily removed. It is interesting to note that, during the entire scene in 1x10 where Santos fiddles with the vial, debating on whether or not to report to Robby, the camera focus is on the vial, not the cap with the glue. If attention were drawn to the cap, that would indicate that the glue is significant and in some way relevant to Santos's suspicions, but it's not. The fact that it's not given focus, combined with the fact that tampering is not brought up back in 01x05, leads me to believe that the glue is not supposed to be a clear sign that the vial was altered.

Langdon may or may not have previously handled that vial and returned it to the PDA

As is pointed out by Dana in 1x08, we don't actually know if this vial is the one that was returned by Langdon. Now, I will agree, if this vial was tampered with, and if the medication inside was diluted, Langdon is the chief suspect, but the point I'm trying to make is that it's not as cut and dry as 'the vial Langdon returned to the supply was faulty, clearly he messed with it'.

Conclusion: Was the vial tampered with? Maybe. Santos clearly think so by the time she reports Langdon to Robby, but Robby and Dana seem unconcerned about both the faulty vial and Langdon's orders for more medication when confronted with them, which raises questions...

Now, for the other factor in the question of 'did Langdon withdraw medication for The Vial™': Langdon. There are a couple things to consider regarding whether or not Langdon withdrew medication from the vial before returning it to the supply:

Langdon's not high on benzos

Now, other people have gone into way more depth than me on this topic, but to put it briefly: benzos are downers. They are used, among others, to treat panic/anxiety disorders, insomnia, and muscle spasms. Symptoms of being high on benzos include drowsiness, lethargy, and loss of coordination. Langdon does not display any of these symptoms in season one. Instead, he's restless, sweaty, and, especially when dealing with Santos, irritable. This lines up much more with the idea that he is, as he mentions to Robby, in withdrawal. Note: this does not mean he's sober during his shift, just on a lower dose than his body has become accustomed to, as he would be if he was trying to taper down.

Langdon was not the one who ordered the additional lorazepam for Louie.

This was a major revelation for me when rewatching episode 1 for this analysis. It's actually Robby who orders additional lorazepam, Langdon is just the one who enters it in the system. Now, in this scene, Langdon is the one who brings up a script for Librium - which makes sense, since he was planning to swipe half of it - but the lorazepam was not Langdon's idea, and was not ordered for the purpose of diverting.

When would he have had time to dilute the vial?

Something other people have brought up (shoutout to @bloomwx) is whether Langdon would have had time/access at all to dilute the vial. I've gone and recorded Langdon's presence throughout the entirety of episode 1, and holy shit, that man is busy. Between when the lorazepam is ordered and when Louie is discharged, there's only one, arguably two, stretches of 3-4 minutes where Langdon's presence is unaccounted for, which is presumably when he collects the Librium for Louie and swipes half of it. That doesn't exactly leave him a whole lot of time to swipe the vial from Louie's room, gather supplies for IV injection, administer the lorazepam in a place where the needle mark wont be noticed, dilute & reseal the vial, and get rid of any evidence. It is possible that he only swiped the vial during this period, perhaps when he was delivering the Librium, and admisistered at some later point in this or another episode, but there is 0 evidence, even on a rewatch, that that vial is burning a hole in his pocket at any point during the episode. Either way, he probably had acquired the Librium by the time he would have stolen and administered the lorazepam.

Langdon doesn't really display any paranoid behaviour until after Santos discovers that Louie is missing pills

The above screenshot it Langdon's reaction in 01x08 when Santos points out that half of Louie's medication is missing. His gaze immediately snaps up to her, and this shot lingers for a moment before the scene returns to Louie's treatment. This is an important interaction. In contrast, he was much more relaxed during their argument about the lorazepam dosage with Joseph Marino, and paid much less attention to Santos than when they're treating Louie. It's only after this moment that Langdon starts badmouthing her to Robby and casts suspicion on Santos's conversations with other people. If he had tampered with the vial, why was that not the trigger for his paranoid behaviour?

There are no supplies for IV drug administration in his locker

NOW, considering his place of work, it probably wouldnt be too hard to snatch the supplies from a stray cart and dispose of the evidence in a random sharps container (we see Santos snatch SH supplies much the same way in S2) but it could have been an easy way for the showrunners to confirm his use of IV meds if they wanted to.

At no point does the narrative ever adress Langdon having diluted drugs

Langdon's whole side of his addiction story, from the discovery to his apology tour in season 2, focusses on the fact that he stole drugs, and that Louie is the one he stole them from. Him sabotaging the ED's medicine supply and Joseph are never brought up again, even when that agruably had the potential to cause way greater harm.

You might ask: why does this matter? And honestly, for the big picture? It doesn't. Whether or not he diluted the vial of lorazepam doesn't change the fact that he was impaired by addiction. It doesn't change the fact that he diverted medication intended for patients. It doesn't change the fact that he fucked up and needed help to get better. However, there is nuance to his addiction, to the way he and other people interacted with it, that can sway a lot depending on whether or not he tampered with the ED's medical supply.

First and foremost: How much control did he lose to his addiction?

Because the circumstances surrounding him diverting the lorazepam and the Librium are very different. The Librium was probably a premediated action where the concequences of his actions were at least somewhat thought through. He selected a patient where he knew diverting carried minimal risk of harm - Louie was a regular and well known for medicating withdrawal with more alcohol, not his prescribed benzos - he ordered the script, creating the opportunity to divert, and he only swiped half the dose, reducing both the risk of discovery and the risk to Louie. Diverting the lorazepam, on the other hand, would have been an opportunistic move. Langdon didn't order the medication and had no control over what would happen with the tampered medication after it was returned to the supply. It would have been a reckless move with far greater odds of discovery and far more risk of harming patients down the line. In one scenario, he is careful and precise, and practicing harm reduction where he can. In the other, he is opportunistic and reckless, and it's a small miracle his diverting wasn't discovered earlier.

Another interesting point follows from this: How honest he was with himself about his addiction?

We know that he is aware that he is at least physically dependent on benzos, because he mentions treating his own withdrawal symptoms. But he also clearly has some level of cognitive dissonance about his level of control over his psychological dependence, what with the whole 'denying being an addict while actively diverting from the hospital' thing. However, the degree of self-delusion that would be required of him to convince himself that what he was doing was a reasonable way for a non-addict to treat their withdrawal symptoms changes quite a bit depending on how exactly he was getting his fix, and it's interesting to consider just how much his addiction had eroded his ability reflect on his actions before he got caught.

Finally, was he really trying to taper himself off of benzos as he told Robby?

From what I could find, it is generally recommended to use benzodiazepines with a long half-life (such as Librium) when treating benzo withdrawal, as it more gently eases the body into lower doses, resulting in less severe withdrawal symptoms. lorazepam, however, has a relatively short half-life, which would result in a much more significant 'crash' as it wears off. Additionally, intravenous administration would result in much faster uptake of the medication than oral, as it does not need to be absorbed through the digestive tract first. I cannot possibly imagine that rapidly spiking and then tanking his benzodiazepine levels would amount to an effective tapering strategy, if that really was what he was trying to do, especially when he had Librium available at that point.

So, yeah. While any form of diverting medication from patients for personal use is, of course, in violation of a bunch of safety protocols and medical ethics standards, whether or not Langdon was divering and diluting IV lorazepam specifically can tell us just how much his judgement of his own actions was eroded, and just how honest he was being with both Robby and himself when he said he was just treating his withdrawal symptoms.

And finally, whether or not he messed with the vial really changes the narrative regarding Santos vs. the rest of the ED when it comes to discovering his addiction.

Because if the medication was diluted, and if the vial was glued shut, then Robby and Dana, the two people in charge of the ED and probably the most experienced professionals to walk its halls, were confronted with direct evidence that Langdon was diverting, and they both shrugged it off. I don't mean that it would be their 'fault' that Langdon got away with it as long as he did, but it could signal that they were too unobservant, too burnt out, or too trusting to notice something so obvious that an intern picked up on it on her first day.

On the other hand, if the vial really was just a fluke, then it's equally interesting that Santos managed to jump to the right conclusion (Langdon is diverting) for the wrong reason (the 'pattern' of inconsistencies with benzos). It suggests that, once she was suspicious of Langdon, every circumstancial piece of evidence got thrown on the pile, even when it didn't hold up to scrutiny, which connects to her broader issues with fathers/male authority figures, and her tendency to assume worst case scenario when it comes to them.

And I do think that difference in how Langdon and Santos perceive his diverting could really add to their conflict. Because from Santos's perspective, his actions affected the whole hospital by sabotaging their medical supply, and affected her specifically by making her doubt her knowledge about dosing medications, whereas Langdon knows he tried his best to minimise the potential fall-out of his actions, both for his patients and the hospital. In this scenario, it makes sense that Santos demands he reveals what he's done, because everyone was a potential victim of his actions, and it makes sense that Langdon takes offense to that, because that's none of her business. The concequences of his diverting are between him and Louie, and maybe Robby as his supervisor.

So yeah, I'm really not convinced that Langdon using and diluting the lorazepam fits into the story surrounding his addiction, both in a logisically, where there is no clear timeline or evidence of him having tampered with the lorazepam, and in the sense that it doesn't necessarily fit into the broader narrative that is presented regarding Langdon's addiction. Langdon is shown to fly under the radar because he's subtle and still functions well as a doctor despite his addiction. The recklessness of stealing the lorazepam stands in glaring contrast to that, especially when, according to the best timeline I can reconstruct, he had already obtained - or at least had created the opportunity to obtain - the Librium, which carried much lower risk of concequences.

I CAN make gifsets without meta-yapping...but where's the fun in that!? So yappage/some expansion and explanation on each of these beats and maybe some talk around bits I didn't end up including (curse u 30-image limit!!) but that are still relevant. Bc this is another one of those 'if I had a nickel for every one...it's weird it's happened x number of times tho' situations.

So I'm not saying it's absolutely definitely for sure a solid 100% canon thing that Frank has some kind of connection to/experience with a close family member/friend with some sort of psych/neurological issue... But I AM saying I'm willing to put a reasonable little chunk of money on it at this point.

Esp when you factor in Joe Sachs saying that, "The secret of our success is we always start with the dramatic needs of our character, and then we go to the well [...] of hundreds of thousands of medical stories."

Which I always factor in bc 1)- it's a great quote/philosophy and 2)- it legitimises my inclination to seek out patterns in the kinds of patients/illnesses the characters treat multiple times and/or how they react to certain kinds of patients/illnesses. So we're gonna talk about both of those things!

We'll go patient-by-patient and in chronological order. Bc I'm a crazy motherfucker like that:

1x02 + 1x06: Beto

First and foremost: I never EVER as long as I LIVE E V E R want any of y'all to come at me and attempt to convince me that Frank Langdon (yes, even season 1 Frank Langdon!!) didn't care/had no compassion or empathy or genuine concern for people/that he had to "learn empathy" between seasons or whatever shit.

That man recognises Beto, an EVS worker who he hasn't seen IN YEARS (and who's implied to have worked night shift previously - so either my 'Frank used to work nights/Robby stole him from Abbot' headcanon may have some merit OR he's just got: that good a memory (his memory is p fucking great btw) REGARDLESS - he recognises him pretty much immediately, remembers him by name (and is HAPPY to see him!!!), remembers that he retired, and remembers him well enough to judge pretty much straight away that he's not himself/that there's something a little bit off here.

At which point he: immediately becomes protective/wants to make sure that he's okay and is being taken care of and goes to check-in with Dana. (That unimpressed/mildly disbelieving 'really?' at Beto's family not coming to collect him for a few hours is also v interesting - keep that in ur back pocket, we shall return to it later).

That and his lil check-in with Beto again in 1x06 is v sweet - and that line to Robby re "that'll be us one day" is....well it takes on a slightly different cast/tone if Frank DOES have any connection to/family history of psych/neurological issues. And Frank? Making jokes/light of a very real situation to #Cope?? Noooo!! He would N E V E R. /s

1x08 - Willie Alexander

I love Willie's case for a lot of reasons - Frank does some EXCELLENT teaching as part of it for a start, but it's also one of the patients we get to see him spend some time with and really get to know/bond with rather than ping-ponging from issue to issue as he's prone to. I also love the way he sits and very obviously eagerly learns from Willie and his history with the Freedom House ambulance service. I also really enjoy the little beat that I've giffed - which is relevant for the discussion of memory/forgetting things vs 'remembering what's important'. But also the fact Frank is obviously happy to see the joking between father and son re Willie's condition/that he Gets that joking and his reaction to it makes him feel included in it/part of it. He feels comfortable and familiar with this sort of thing.

He's also great with Willie re explaining to him the procedures that are going on, and talking back and forth with him re his medical knowledge and giving repeat reassurances - but he doesn't dismiss him or not explain things to him, or simply talk to Eli (his son), he makes sure Willie's kept in the loop and is aware of what's happening with him and why (which sounds hella basic/like it should be a given but it is: not. Esp not for older adults/those with problems like dementia or otherwise).

2x02 The Hansens

I got a lotta thoughts re this family and their gift that keeps on giving to the ED, keeping 'em ticking over through the hours. And I see a lot of parallels/things to yap about with regards to Frank's interactions with them. But for the purposes of this I'm honing in on Frank: dissociating to fuck/zoning the heck out and just doing his job in a v mechanical way until we start getting 'crazy' and 'psycho' thrown around - and he picks up the connection to the racing family, but he also definitely reacts to those terms/the idea of it running in the family. Those lines feel Deliberate/we could've said anything here to bring up the grandads names but instead we dropped more breadcrumbs.

2x11-2x12 Micah Azurmendi

Frank and Baran share many #SignificantLooks between these cases, but this is one where I think Frank's reactions are more telling than what's going on. But first off, the look between Frank and Baran re potential damage to Micah's brain is Interesting (Baran's connection to this case/to neurological complications is fairly obvious, given her seizures - Frank's less so). But both he and Baran are fairly firm in not judging Brenda or jumping to the conclusion that she harmed Micah deliberately (both are actually fairly firm on NOT making that judgement in how they speak about the case/react to others, which feels v interesting to me).

I will acknowledge here, too, that there are obviously some parallels/connections to be drawn between a parent accidentally (or otherwise) harming their child and being unable to see them with the potential for what might have happened to either Tanner or Penny had they ever found/taken any of Frank's benzos during his addiction/the fact that at some point over the 10 months, Abby apparently threatened divorce/Frank was afraid he might lose his kids. I'm sure there is definitely an element in there (esp with Micah being around Tanner's age) but I think there's more to this case, largely around how Frank behaves with regards to Micah's mum.

ESPECIALLY because of the difference in how he reacts with Brenda/her case here vs how he responds towards Tyler (pot-gummy boy from s1) and his parents. In that case he's a lot more cynical, after Mel expresses concern over seeing families torn apart, he assures her that they'll be fine, and she asks how he can be so sure, to which he replies, "They're white. Probably get off with a slap on the wrist. If they weren't, she'd probably lose her child and he'd end up going to jail, but–" - I've commented on this scene before and it's INTERESTING, because it's a side of Frank we don't see all that often (not so much the cynicism/snark) but there's....there's definitely a feeling of something like bitterness in him here. He knows the system prioritises/will let white families away with things others won't get away with and there's a feeling like he knows this to his cost/it's definitely not something he approves of.

For the purposes of this, tho, it's night and day vs how he reacts towards Brenda's case/circumstances.

2x11-2x12 Brenda Azurmendi

Frank is shown numerous times (which I giffed above for ur consumption and enjoyment!) to be very concerned about/protective towards Brenda. As stated he repeatedly avoids casting doubt/judgement on her for having intentionally harmed her son - he also advocates for her/asks after her multiple times.

-The very obvious concern he shows when Brenda has a 302 called/is placed on a hold and his first query is whether or not she's going to be able to see her son (which, interestingly (to me) he directs towards Baran, not Robby, even though Robby is his typical/instinctual go-to for answering questions/fixing things that have gone wrong in the world. Then the follow-up on what happens if Micah is ready to be discharged before Brenda is herself? - That second one is actually almost more interesting to me than the first; because it DOESN'T align (at all) with Frank's life/experience with HIS kiddos. Because even if/while he was in rehab and unable to see or look after them - he knew that they had Abby.

-Then the question (again to Baran) on if she thinks that Brenda will be okay. Frank... I don't think we've seen Frank question this about any of his patients before (most of them I think he KNOWS how they are/how they're going to be because he's worked on them and knows the next steps. Brenda's case is a bit more up in the air/uncertain - this isn't something with an easy fix or answer - but it also feels like he's seeking reassurance/this is a situation that he's worried about/that he's dwelling on a bit and wants to talk about, and he knows Baran cares as well and that she's spoken to Brenda at this point, so he's looking for a follow-up on the case, but it's obvious he's concerned/this is more than just a purely clinical 'what are the next steps' kind of a question - he's obviously worried.

-More #SignificantLooks exchanged between him and Baran when Brenda asks if she killed her son. I think, again, worried FOR her rather than worried at what she might have done (even after this he still doesn't cast judgement/in the next beat where they talk about her husband visiting he's still very clearly feeling protective towards Brenda/isn't seeing this as an admission of guilt but rather an indicator that she's not okay/needs help herself).

-Aaand yes there we go that brings us onto him obviously feeling Some Kinda Way about the fact her husband didn't come to see her or check-in at all about her but just went directly upstairs. And we get a reprisal of that disbelieving/judgemental 'really???'. Which, okay, the one word is a fun lil connection/parallel but not necessarily deliberate, however, the TONE/this being the second time Frank expresses fairly obvious judgement/disapproval (which - is actually NOT that typical for him at all, honestly, he doesn't tend to show particularly strong feelings/reactions towards any of his patients regardless, he just treats them).

But THIS? This is something that GETS him and that draws a notable response/judgement from him both times, and in both cases, it's a scenario involving a person with likely psychiatric issues and their family not coming to see them/get them straight-away/perhaps not showing enough concern for or acknowledgement of the seriousness of the issue? Uncertain. Either way, in both cases Frank is obviously Concerned/not a happy bunny, and there's definitely an instinct of care/protectiveness towards both of them.

I just. I Feel it, people, i Feel It, Frank's close with someone who's had additional care needs - maybe where those WEREN'T respected/he/they had to fight for that. I FEEL IT OKAY.