Miami Medical (2010) s01e02 Episode Script
88 Seconds
Hey, Swizz, I think I just woke up On the right side of the bed That's how I feel I think I might give away a million bucks I think I might give away a brand-new truck 'Cause I feel good Yeah, I feel good, 'cause I feel good I think I might take you on a shopping spree You in the club, damn! All drinks on me 'Cause I feel good Yeah, I feel good 'Cause I feel good Hey Starting to worry about you.
How late am I? Like, 15 minutes? Let me guess.
Traffic on the Causeway.
Second Avenue Bridge was up? The only thing up was me.
All night.
Dylan got food poisoning.
Oh, poor little guy.
He stay home from school today? Yes, which means I had to find a sitter at the last minute.
Either that or a new job where I can bring along a six-year-old.
(chuckles) Oh, crap.
Do you see my Time card? Punched you in five minutes early.
Eddie, you are a lifesaver.
Don't I know it.
Hey, I'm dying of thirst.
Can we get a whisky sour down here? Just give me one second.
I'll be right with you.
Just one damn vodka tonic.
How hard could that be? Well, that depends.
Do you want a whisky sour or a vodka tonic? Hey did I stutter? No, but you ordered two different Just bring me my damn drink.
Hey, behave yourself, or I'll have to escort you off the premises.
Get the hell off me, bro.
Hey! You better settle down, buddy.
I'm warning you right now.
Thanks, Eddie.
(distant, distorted): Kids gotta eat They can have every last penny on me Me and Swizzy rollin' in (heart beating, dishes clattering) (slow, labored breathing) It's not what you think.
I'm a diabetic.
(heart beating slowly) (crashing, screaming) MAN: Fight! There's a fight! Eddie! Eddie! Call security! Hey, one shot for my Two shots for my I feel good, I'm so good (gunshots firing) Someone's got a gun! (people screaming, gunfire continues) (groaning) (gunfire, glass shattering) Kate Kate! Someone call 911! Kate! Here it comes Here it comes Here comes your 19th nervous breakdown.
Dr.
Proctor? Dr.
Proctor? Nursing said I could find you here.
We've got incoming.
A hotel shooting.
Yeah, I know.
On Ocean Drive.
Gunman's still on the loose.
Multiple GSWs.
It's 12 minutes out.
Hey, Dr.
Warren? If I were to jump, and, uh, end up in your trauma bay, what injuries might you expect to see? Traumatic brain injury.
Multiple long-bone fractures.
Major organ damage to the liver and spleen.
And if I jump from the second floor? Much shorter fall, so isolated lower extremity trauma.
Specifically? Ankles and heels.
You're not planning on jumping? Oh, I might if I was still doing hemorrhoidectomies on Baltimore fat cats.
And look at that.
There's no sun like this in Maryland.
Should we get to work? Oh, nicely done, by the way.
Especially for a first-year resident.
Hey, Chris.
How many incoming? Five GSWs and two red-bands, milady.
Milady? I'm just trying out a little fresh verbiage from across the pond, what with (British accent): the new dynamic on Alpha Team.
Well, in that case, I prefer "Your Almost-Royal Not-Quite-Highness Zambrano.
" It's not every day your new boss comes with a plate of fish and chips.
MAN (over intercom): Patients are incoming.
Four minutes out.
Do you have to lose your mind to become an attending surgeon here? First Dr.
Rainer waltzes off the job naked as a newborn.
Now, Proctor's upstairs hanging off the side of a building.
Is this normal? No.
Nothing normal about Proctor.
What I can tell, great surgeon, but as a person, slightly left of slightly left of slightly left of center.
Did you get a look at that scar? Mm.
What scar? Sternotomy.
Tissue's still pink.
He had his chest cracked.
And recently, too.
He said he was military, right? Maybe he got fragged.
don't they usually shoot him in the back? (pagers beeping) All right, incoming's two minutes out.
Let's move it.
I'll prep Trauma 1, crash cart, and thoracotomy tray.
Call blood bank.
Let's have plenty of O-neg on standby.
Will do.
Speaking of calls, I got an interesting one this morning.
You're going to make me ask? Headhunter.
Looking for trauma fellows boarded in critical care.
You jumping ship, Chris? What, chief resident isn't enough for you? Well, I'm not thinking of me.
Oh, you trying to get rid of me now? No.
Listen, believe me.
If you leave, I'm the next one out that door.
It's just I think you should've gotten your own team.
Look, I'm a trauma fellow.
Proctor has 15 years of experience on me.
It makes total sense.
Okay, and then what if things don't work out between you and his lordship? You have to agitate, don't you? It's like a disease.
No, I think of it as more of a gift.
Kate Prentice, 23-year-old female.
GSW to the right leg.
She's hypertensive.
BP's 78/40.
We got two liters running wide open.
Where? You're at Miami Trauma 1.
Which means you're about to get the best trauma care in the 48 contiguous states.
And Alaska and Hawaii.
He always forgets Alaska and Hawaii.
I'm Dr.
Deleo.
This is our charge nurse Tuck Brody.
My son Dylan.
He's with his babysitter.
Okay, we'll get all of the babysitter's information and make sure that Dylan's taken care of.
But, right now, we got a sliver of time that'll make a big difference in your recovery, so you lay back, we'll make you better.
DELEO: Kate Prentice, Dr.
Eva Zambrano.
Now, Dr.
Zambrano's going to tell you that she outranks me, but, trust me, I'm a better doctor.
Ready? Let's get her on the table-- one, two, three.
Kate, do you have any medical conditions we should know about? In Insulin.
Diabetic.
Okay, let's get a stat Accu-Chek, and, uh, someone page, Proctor, huh? How's her respiratory status? Uh, breath sounds are clear bilaterally.
And minty fresh.
WOMAN: Sat's 92 and she's hypotensive.
No, thanks.
Never saved a chart before.
You don't want to make the attending's notes? I'd rather get my hands dirty than stand around and supervise.
Okay, we need to get her pressure up.
How long since you were shot, sweetheart? I don't know.
Paramedics reported 20 minutes.
We're going to have to roll you, Kate, and check your back for the bullet entrance.
Now this may hurt a bit.
Hold C-spine.
Ready? (heart monitor beeping) And (screams) Entrance wound.
(groaning) Check for depth and trajectory.
Next chopper is six minutes out.
Should give us plenty of time to get her stabilized.
Probing a little deeper.
(alarm beeping rapidly) We lost her pulse.
Cycle pressure.
V-fib.
She's arresting.
Need paddles.
(defibrillator power whirring) Everybody clear.
(defibrillator zaps) (monitor beeps steadily) She's back in sinus.
Strong pulse.
Okay.
A 23-year-old woman should not be going into V-fib from a bullet that's nowhere near her heart, right? I need a thoracotomy tray.
Let's get our patient's chest open and see why she arrested.
Hold that thought.
I'm sorry? She's back in sinus.
Got good rhythm.
Ultrasound, please, and bolus 150 migs of amiodarone.
Let's stabilize the heart.
She went into cardiac arrest from a gunshot with normal blood count.
That's a heart injury until we prove otherwise.
Which is what we're about to do right now.
(heart monitor beeping steadily) I'm sorry.
I forgot to use my turn signal.
You're right: we will probably have to crack her chest, but let's make sure we exhaust every other option first.
Okay.
(heart beating) No bleeding, no effusion.
Her heart is fine.
How did you know that? BLT.
Is that a is that a drug or a procedure? It's a sandwich.
See, there's an order to things.
You put the bacon on the top with the lettuce in the middle and the tomato on the bottom.
Do you ever try and change the order? No.
Wouldn't taste right.
Point is, if there's a problem with the tomato, then assume you'll find an answer by looking at the bacon.
Got two more incoming.
Both GSWs.
I'll take them.
Get Kate upstairs for an ex-lap.
Page me when you get her abdomen open.
Bacon, lettuce, and tomato? The guy's hungry.
I swear, sometimes, it's like he's speaking in tongues.
He was right about there'd be no cardiac injury, though.
You know, at least with Rayner I always knew what was coming.
We'd be in the middle of a bowel resection, he wouldn't have to say anything.
I just knew.
Three shifts now with Proctor, and still, I have no idea what this man's going to say next.
Me either but I do enjoy it when you say "bowel resection.
" (man groaning) What've we got? Scott Sumner, 32 years old.
Comminuted open femur fracture from GSW, altered mental status.
My leg burns! Burns! Can you hear me, Mr.
Sumner? I need water! Water! Okay, let's get him into Trauma 1.
Check his cap refill and distal pulses.
Make sure he has blood flow to the foot.
I got a 27-year-old female, GSW to the left arm.
BP's 110/70.
Motor and sensory exam intact.
Pressure's good.
Wound is distal and she's stable? You're new, right? We do trauma only; penetrating injuries to the head or torso.
Low BP, diffusive abdominal pain, falls over 15 feet.
You get the picture? We do golden hour.
That's circling the drain, meet your maker.
If they're not dying right now, then they go to the regular ER, which is outside and around the corner.
Come back by after your shift.
I'll introduce you to the killer cafe cubano at our coffee cart.
I gotta get to the O.
R.
So can you? Stem the bleeding on the drunk and do a full trauma workup.
Yeah.
And? Page Ortho and set up a consult, but Is there a problem? No.
It's just I've never really done a case solo before.
Okay, so get him stabilized and page me if you get into trouble.
Page me two minutes before she gets into trouble.
You got it.
All right, let's find the source of Kate's V-fib and get her closed up again.
If you can retract the muscle for me, please? Thank you.
Hang on.
Looks like the bullet nicked her kidney.
If I could just reposition to get a better look.
(alarm beeping) Tachy 175.
BP: 245/115.
Still nowhere near her heart.
Everyone freeze.
(alarm stops) Wait.
Wait.
Look.
What? Right there on top of the kidney.
Some kind of mass.
Looks adrenal.
It's small.
Doubt if it's even been diagnosed.
Adrenal tumor.
How cool is that? Cool? Okay, think-- how would that type of tumor present Come on.
Excessive sweating, elevated heart rate, pressure, tingling in her hands and feet The tumor's causing her diabetes.
It'd certainly explain her diabetic symptoms.
If we could just get down to the retroperitoneal space and get a better (alarm beeping) The tumor's sitting on top of the adrenal gland, which means that every time we touch it We're dumping adrenaline back into her system, cranking her heart rate up from zero to cardiac arrest.
So if we don't fix the kidney and she eventually bleeds to death, or we do fix the kidney and we risk triggering a fatal heart rhythm.
Ain't that a hornet's nest? Okay, Chris, get her to C for a metastatic workup.
I want to see if that tumor is cancerous.
I'm on it.
Eva, get her lacs back stat.
I want to know what we're dealing with before that kidney hemorrhages again.
(groaning) Water! I need water! You're getting I.
V.
fluids right now, sir.
We need to make sure you're stable so we can fix your leg.
Let me up! Let me up! I'm fine! Hey, hey! Go ahead, Dr.
Warren.
Have you taken anything, sir, besides alcohol? (mumbles) What was that? (mumbling) Can you repeat that? Let me go! Can we get some restraints? (yelling, muttering) Who's in charge here? Me.
I got paged to come down for an Ortho consult.
Yeah, uh, bleeding stopped with pressure, BP's stable, but I'm concerned about the patient's altered mental status.
Of course he's altered.
He's drunk off his ass.
Could be alcohol-related, but there's also a chance it may be metabolic or from head trauma.
What are you, like, 12 years old? I'm first year trauma resident.
Well, this is my 20th year as an attending orthopedic surgeon, and my job is to make sure that man doesn't lose his leg.
I understand that, but he's not ready.
You got "residentitis," Dr.
Warren.
You're fishing for an exotic diagnosis.
This one's just drunk.
You'll learn.
Prep the patient.
Move him to O.
R.
3 and page Anesthesiology.
Patient's name is Kate Prentice-- P-R-E-N-T-I-C-E.
Test for catecholamines and metanephrines.
We're trying to I.
D.
her tumor.
Page me as soon as you get the results back.
Thank you.
Excuse me.
Uh, Kate Prentice-- you her doctor? Are you family? Friend from work.
I brought her purse.
Thought she might need it.
Is she, uh is she going to make it? We're doing everything we can.
They still haven't caught whoever shot her, have they? (P.
A.
beeps) (purse thuds) WOMAN (over PA): Paging Dr.
Bender Your arm okay? Sure.
Why? You dropped the purse.
I did.
Has anyone looked at your eye? No, I'm fine.
I just got into a fight with a drunk guest.
When was this? Right before the shooting.
Mind standing still for a minute? Okay.
Um, sir, you need to sit down.
What for? I think you've been shot in the back of the neck.
Oh, no, I haven't.
Can you do me a favor? Can you look right? Come on Now left.
This is I need a gurney here! I can't move my arm! Okay, okay, just relax.
It's Eddie, right? Eddie Del Valle.
Okay, Eddie.
I'm Dr.
Zambrano, and this is our lift team.
What's wrong with me? You've been shot.
Shot?! Without even knowing? You'd be surprised how often it happens.
Now, I think the I think the bullet is pressing against your spinal cord.
So every time you turn your head, it's causing a temporary loss of function in your arm.
Loss of what?! No! No, no.
No, no, no, no.
Stay calm.
Eddie, it's temporary now, No! No! but it can become permanent if you move too much, okay? (speaking Spanish) Eddie! C?mate.
Okay, Eddie! C?mate, c?mate, okay? No te muevas.
Okay.
Okay No te muevas.
Roll him.
Eddie, where are you from, huh? Where's home? Born in Cuba.
Yeah Me, too.
What part? Holgu?.
I've never been there.
What's it like? Beautiful.
Beaches, white sand.
I was born in Havana.
I left when I was six.
Okay, lift him.
One, two, three.
My mother still lives there.
I send her money every month.
If I'm paralyzed and I lose my job, they're going to take away her house.
Let's make sure the next time you see your mom, in her own house, you can hug her with both arms.
O.
R.
3, get fluids in him and I want him on the table in five minutes.
Dr.
Proctor What happened to you? Huh? Zygomatic arch? Oh, it's nothing.
I wanted to update you on Scott Sumner-- comminuted femur fracture.
Better make it fast.
I got a couple of post-op patients to check in ICU.
Okay, uh, Mr.
Sumner is in surgery.
Ortho took him to repair the fracture, but I still have concerns about his mental state because I wasn't able to finish his workup.
Then why is he in surgery? The orthopedic surgeon wanted to get him upstairs immediately.
Dr.
Warren, um that patient is our responsibility.
Until he's cleared from Trauma, you don't just release him to another doctor.
But he was an attending.
He runs a department.
Not this department, right? What's more important: a doctor's rank or a patient's life? Now, do you still think there's something wrong with your patient? I'm concerned his altered state is something more than just "drunk.
" Fine.
Go and prove it.
DELEO: Kate, the anesthesia from the surgery's going to make you feel groggy for a while.
So, I don't have diabetes? Oh, no, you do have diabetes.
It's just that yours is caused by your tumor.
(laughs groggily) That's a relief.
Shame to think I wasted two years shooting up insulin for nothing.
Well, good news is that once that tumor goes away, so does your diabetes.
Initial scan shows no other masses in your chest or abdomen, so it means your tumor's probably benign.
Oh, so I'm going to be okay? I wouldn't buy your lottery tickets yet, but things could be worse.
(over intercom): Did they catch him? The guy who shot me? It was a guy? What No.
I, I just assumed.
It's scary.
The cops are looking for the shooter.
Oh, my God.
Dylan, my son.
Don't worry, Kate.
We left word at your house.
No, you don't understand.
His dad died when he was two.
I'm all he's got.
You've got to keep me alive, okay? One thing at a time, Kate.
First, we gotta get you stabilized.
Dr.
Deleo? What? That.
Print it for me.
Are these all the labs for the drunk with the leg fracture? It's everything we ordered.
Something's missing.
Want me to call down to the lab, see if they dropped a test? No, it's not the lab.
It's me.
If I don't find the answer, we could lose him.
Anything I can do? Lifeline, phone a friend? Okay, person came in intoxicated with altered mental state, but also showing signs of polydipsia.
Hmm, excessive thirst, screaming for water, right? And according to his initial lab work, he's severely acidotic.
Alcohol intoxication alone shouldn't cause that.
Something else did.
Right.
But what? (sighs) Prep O.
R.
1, have Endrocrine on standby.
Page me in 15.
Excuse me, Dr.
Deleo? Heidi Pelton, Med-Trac Recruitment.
I've left you several messages.
Ah, the headhunter-- right, right.
You're a hard man to track down, but the best ones usually are.
I'm sorry.
I really don't have time to do this right now.
You've come a long way from Lake Wimico.
(chuckles) Okay, so you've done your homework.
So have you.
Top of your class at FSU.
You could have your pick of positions.
Heidi, is it? Mm-hmm.
Heidi, I'm flattered, but I'm not leaving MT 1.
Okay.
Maybe I can change your mind.
Jacksonville Surgical Hospital, Brand-new facility, state-of-the-art O.
R.
suites, looking for top-shelf chief resident.
I'm sorry, but I'm I've been up for 36 hours on call.
I have to jump into this hellacious surgery.
What if you could cut your on-call hours in half? Schedule your own surgeries, double your salary.
My number's on the back, in case you want to discuss the offer.
Eddie Del Valle, your GSW, is up in O.
R.
1 for the bullet removal.
Good.
Get him prepped and the propofol running.
Then page me when he's under.
Hey, I got to find Proctor.
Have you seen him? Just got a page.
He wants us both on the roof.
The roof? What Do we do we have more incoming? No.
I just think better outdoors.
Clears the mind.
Is he eating a BLT? Uh What'd you find? Bullet hit the renal hilum.
We didn't see it before.
It's only a matter of time before the whole kidney ruptures and she bleeds out.
We got to get her into surgery, get that tumor out, fix the kidney.
Yeah, but if we so much as breathe on that tumor, she's going to code.
You think we should wait? I think we should infuse her with alpha-beta blockers to counter the adrenaline.
Let the drugs run 48 hours before we operate.
She has a high-grade kidney laceration.
It's a ticking bomb.
Yeah, but if we operate now, she can die on the table.
And if we don't, then she could die the next time her kid hugs her.
Okay.
Heads we take the tumor now.
Tails we wait 48 hours.
You can't be serious.
Why, you want heads to wait? We can't decide off a coin flip.
Does seem capricious, doesn't it? What's it going to be? We take the tumor now.
After we run alpha-beta blockers for at least an hour.
Excellent compromise.
(elevator bell dings) (pagers beeping) New incoming.
I'll take this one.
Chris and Eva, can you get Kate's meds running? Uh, I got O.
R.
2 with my GSW to the neck.
Fine, Chris can prep.
Page you when I'm ready.
Maybe you can page her from upstate.
'Cause I hear the, uh, weather is lovely in Jacksonville this time of year.
What? Jacksonville.
You know, the river city.
Home to the second largest jazz festival in America.
First inhabited by the Timucua Indians over 6,000 years ago.
You know if you're looking for a stress-free job, I do know of a recently vacated position in a GI practice in Maryland.
(laughs) Not really sure what you mean.
No? No.
But then I'm not a beautiful blonde with a glossy brochure, am I? (monitors beeping steadily) All right, Eddie, let's make it so you can go see your mommy in Cuba.
No more bullet.
If you'll close, I'm going to fight to get Eddie a bed in the crowded ICU.
(chuckles) Uh, whatever you're looking for, I'm sure there's a nicer place to find it.
(sighs) Trust me, I'd much rather be poolside in South Beach right now.
Except for the crazed gunman who's on the loose.
They haven't caught him yet? Police are still looking.
It's really scary.
Everything okay? (sighs) Considering I've been punched in the face, had a patient stolen from me by an attending, and now I'm Dumpster-diving for medical evidence, best day in the history of residency.
Who stole your patient? I think his name was Kaye.
As in Angry Ortho? He accused me of residentitis.
Yeah, well, Kaye's a rite of passage around here.
Everyone has a run-in with him at some point.
Trick is to anticipate him.
Get inside his head.
How do you do that? I'm the wrong person to ask.
The way things have been going with Proctor lately, I What's he doing now? Uh, holding consults on the roof, flipping coins, eating deli sandwiches.
What are you looking for, anyway? Wish I knew.
Scott Sumner, drunk GSW from the hotel shooting, his labs are all over the place.
How do you figure out what's wrong with a patient you can't have access to? Process of elimination.
(sighs) What goes in has to come out.
Greg Wilson, male, GSW to the face.
Arrested en route, unable to intubate in the field.
Another gunshot victim? Self-inflicted.
Cops chased him down Ocean Drive, tried to kill himself before he got arrested.
PROCTOR: Why were they chasing him? Because he's our hotel shooter.
(engine roaring) (monitor beeping rapidly) No pulse.
He's in asystole.
Continue CPR.
I'll find an airway.
(alarm beeping) (flatline tone sounding) (suction slurping) Not much of his face left.
We're going to have to cric him.
(flatline tone continues) Scalpel.
4.
0 trach tube.
I'm in.
Can we get some hands in here? (groggily): Have-have you been able to reach my son? Babysitter's on her way.
No, but I don't want to go under before I see Dylan.
Can't we can't we wait? Every minute we wait is a greater chance that your kidney could rupture.
So we got to get that tumor out.
We got to stop the bleeding.
And then we'll deal with the bullet.
You stopped joking with me.
What do you mean? That just from the moment I've arrived, you've been making me laugh.
I guess the end of the jokes means things have gotten pretty bad.
(elevator bell dings) Mommy! Hey! Peanut! Oh, I'm so glad you're here.
Epi's in.
Hold compressions.
Still asystolic.
Resume CPR.
Another mig of atropine.
Dr.
Proctor.
He's leaking brain matter.
There's nothing more we can do.
I'm calling it.
Time of death: 15:33.
(flatline tone stops) I'll call down to the morgue.
(groans) That hurt? My neck's killing me.
I think I need more pain meds.
You got two milligrams of oral Dilaudid.
And two more now before that.
I guess it's not working.
Let me ask you, did you take those with milk or apple juice? I don't know.
Why? 'Cause the malic acid in the juice can blunt the drug's effectiveness.
(sighs) I think it was with apple juice.
That's interesting.
'Cause I just made that up.
And since there's no apple juice in your trash, and this hasn't been opened, Eddie, have you been cheeking your meds? What No.
Eddie.
(sighs) They're for my mom.
(sighs) Her ulcer's hurting her real bad.
Been sending her money for pain meds, but she can't buy 'em.
Why not? It's Cuba.
Where there's never enough of anything.
I was just trying to help her.
And I figured a little pain ain't going to kill-- (gasps) All right, I'm putting you on I.
V.
pain medication from now on.
No more orals.
(sighs) Alpha-beta blockers are running.
You ready? So if this goes well, no more diabetes, no more tumor, no bullet.
Like a do-over, right? This is just like a do-over.
Okay, listen, I need you to get her under.
Page Dr.
Zambrano for me.
All right? Tuck.
Went back through the drunk guy's labs to eliminate causes acidosis-- nothing, right? Then I went through the trash bin in Trauma 2.
Found this.
What do you see? This a trick question? Ethylene glycol poisoning causes urine to glow.
That explains the acidosis, the altered mental state I don't know how it got in his system.
Ethylene glycol, as in antifreeze? Yeah.
Why? A serious drunk can get rid of the shakes with a couple of sips.
Wait, he was drinking antifreeze? Wouldn't be the first I've heard of it.
(pagers beeping) "Code Blue, O.
R.
3.
" Hey, isn't that your patient? Clear! Still V-fib.
Push another 150 milligrams of Amiodarone.
Prepare to shock again.
Everybody take a step back.
We're going to bolus him three amps of bicarb, and run this antizole.
What the hell are you doing? Trying to save my patient.
You have no standing here.
His labs came back positive for ethylene glycol; he was drinking antifreeze.
Again with the exotic diagnosis.
Labs don't lie, Doctor.
You want to argue or you want to make this man better? Bicarb and antizole are running.
Carotid pulse is strong.
You got him back.
Before you say anything, we both know that was my patient.
Drunk or not, I never cleared him.
But you ignored that and you put his life at risk.
Or maybe you just woke up this morning and decided to ignore the Hippocratic oath.
Dr.
Warren And another thing: I don't care how young I look.
I am a trauma surgeon, and don't you ever forget that.
I was going to say, Dr.
Warren nice work.
Oh.
Thank you.
DELEO: She's starting to bleed into her abdomen.
The kidney's just oozing.
Focus on the tumor.
First, tie the vein from the adrenal gland.
So the adrenaline can't flow back into the heart.
This ain't my first rodeo.
Okay, cowboy.
Get a retractor in.
Easy.
Little more to me.
There (alarm beeps, then stops) Take it slow.
It's like that game, Operation.
Don't touch the sides or (alarm beeping rapidly) (beeping stops) Metzenbaum scissors.
All right, let's get this bad boy out.
Adrenal tumor, 500 points.
All right, let's close now.
She called this her "do-over.
" Who? The patient, Kate Prentice.
You think that's possible? A do-over? Maybe you should ask Proctor.
What do you mean? Well, the guy shows up out of nowhere, big scar on his chest, past he doesn't want to talk about.
Sounds a lot like a guy who's trying to have his own do-over.
(alarm beeping rapidly) Pressure's dropped.
What just happened? Her abdomen's filling with blood-- I need lap pads.
Did you hit the kidney? No, I didn't touch it.
It just blew.
First the bullet, then the tumor, now the kidney.
(monitor beeping rapidly) 2.
0 cro-mig.
And someone page Proctor.
We need him in here now.
What's her status? Got the tumor out.
Kidney blew up like the Hindenburg.
We tried pressure and over-sewing, but she arrested from blood loss.
Did you cross-clamp the aorta? Done, and we got her back.
But when we unclamped, she coded again.
It's like digging a hole in the sand.
I repair one part of the kidney, another one opens up.
Okay here we go.
Let's have a look.
Blimey! Impressive amount of suturing.
Give her two more units now and a vasopressin I.
V.
(alarm beeping) I can feel her heart.
It's fibrillating.
Internal paddles.
Bring her back.
Sutures keep tearing.
Clear.
(defibrillator zaps) Still fib.
Clear.
(power whirs, paddles zap) Her heart's pumping.
She's in sinus.
Okay.
Here we go.
Clamping the renal vessels.
I already tried over-sewing.
Yeah, I can see that.
If I can't fix her kidney, you can't fix it.
So why waste any more time trying to do that? Scalpel.
Wh What are you doing? Sometimes the best way to fix a problem is to eliminate it.
You took the whole kidney.
Good thing she only needs one.
Bovie to me.
See, here's the thing: it's 1991, AIDS evac hospital outside Kuwait City.
I spent four hours pulling shrapnel from a damaged kidney-- tiny, little slivers of metal like, uh well, like human hairs.
And I'm so focused on fixing my patient that I nearly killed him.
So, eventually, my chief steps in and just whips out the whole thing.
You see, the kid's mom wasn't going to count organs when she hugged him.
And neither will this young lady's son.
Eva.
Unclamp the aorta.
(monitor beeping steadily) Vitals are holding steady.
And the field is staying dry.
You mind closing? All right, so, your bullet wound is healing nicely.
No signs of infection and it looks like you're going to go home in a few days.
And one more thing.
Toma.
What's this? My father was a well-respected surgeon in Cuba.
And he still has connections.
I don't understand.
Well, just have your mother call that number.
It's a private clinic in Havana.
They treated Castro's ulcer a few years back.
I, uh (gasps) I don't know what to say.
Just Just send me some photos of Holgu? next time you see your mami.
Okay? Thank you.
Yeah.
You take care.
Dr.
Proctor, you get my page? Frank Wilson, the hotel shooter-- I was going through his clothing.
Found this.
What's that? That's him with Kate-- our waitress, right? Yeah, looks like she knew the guy.
So, who was he? Don't know.
The police are still trying to figure it out.
But whoever he was, he wanted Kate dead.
(knocking twice) You're going to be here a few more weeks.
But, um, as soon as we release you, we're expecting you to make a full recovery.
So I would say that now's probably a good time to buy those lottery tickets.
(both laugh quietly) You're joking again.
Yep.
That's a good sign, right? And want you up and out of this bed as soon as possible.
I don't think I'll have much choice.
It hurts when I breathe.
PROCTOR: That's normal when you've had your chest cracked.
It's nothing permanent.
It should go away in a couple of months.
You, um you might have a hard time sleeping.
Not through anything physical, but, uh It's hard.
Yeah, the police were here earlier.
They told me about Frank.
The guy who shot you.
My ex-boyfriend.
I had a restraining order against him in Georgia.
I had no idea that he followed me here.
You don't have to worry about him anymore.
I guess I get my do-over.
Yeah.
I guess you do.
Quiet up your mind and let me in DELEO: This thing presents itself as a simple GSW, and ends up a total nephrectomy on top of an adrenal tumor.
It's unbelievable.
You know, right before Proctor took the kidney Yeah? I knew exactly what he was going to do.
Really? Mm-hmm.
I'm not sure how, but I just knew.
(imitating Yoda): Hmm, progress you are making.
More powerful you have become.
Okay, dork you are.
Yeah.
See you tomorrow.
Okay, see ya.
I know it's hard to get to know your pain You try to hide it over again But that only puts you deep down Jacksonville.
What's a hard time? You told Kate, "You might have a hard time sleeping.
Not from anything physical"" I know it's hard to lay it all down And feel the world all around you That's the only way, that's the only way I The scar on your chest-- what happened to you? 88 seconds.
What? I was coded, right? I was flatlined.
Time of death called.
I was gone for for 88 seconds.
My do-over.
Dr.
Proctor Have you ever noticed, at this time of the evening, just before the sun goes down, how the light seems to kind of just drip towards the horizon? So softer now Softer now.
How late am I? Like, 15 minutes? Let me guess.
Traffic on the Causeway.
Second Avenue Bridge was up? The only thing up was me.
All night.
Dylan got food poisoning.
Oh, poor little guy.
He stay home from school today? Yes, which means I had to find a sitter at the last minute.
Either that or a new job where I can bring along a six-year-old.
(chuckles) Oh, crap.
Do you see my Time card? Punched you in five minutes early.
Eddie, you are a lifesaver.
Don't I know it.
Hey, I'm dying of thirst.
Can we get a whisky sour down here? Just give me one second.
I'll be right with you.
Just one damn vodka tonic.
How hard could that be? Well, that depends.
Do you want a whisky sour or a vodka tonic? Hey did I stutter? No, but you ordered two different Just bring me my damn drink.
Hey, behave yourself, or I'll have to escort you off the premises.
Get the hell off me, bro.
Hey! You better settle down, buddy.
I'm warning you right now.
Thanks, Eddie.
(distant, distorted): Kids gotta eat They can have every last penny on me Me and Swizzy rollin' in (heart beating, dishes clattering) (slow, labored breathing) It's not what you think.
I'm a diabetic.
(heart beating slowly) (crashing, screaming) MAN: Fight! There's a fight! Eddie! Eddie! Call security! Hey, one shot for my Two shots for my I feel good, I'm so good (gunshots firing) Someone's got a gun! (people screaming, gunfire continues) (groaning) (gunfire, glass shattering) Kate Kate! Someone call 911! Kate! Here it comes Here it comes Here comes your 19th nervous breakdown.
Dr.
Proctor? Dr.
Proctor? Nursing said I could find you here.
We've got incoming.
A hotel shooting.
Yeah, I know.
On Ocean Drive.
Gunman's still on the loose.
Multiple GSWs.
It's 12 minutes out.
Hey, Dr.
Warren? If I were to jump, and, uh, end up in your trauma bay, what injuries might you expect to see? Traumatic brain injury.
Multiple long-bone fractures.
Major organ damage to the liver and spleen.
And if I jump from the second floor? Much shorter fall, so isolated lower extremity trauma.
Specifically? Ankles and heels.
You're not planning on jumping? Oh, I might if I was still doing hemorrhoidectomies on Baltimore fat cats.
And look at that.
There's no sun like this in Maryland.
Should we get to work? Oh, nicely done, by the way.
Especially for a first-year resident.
Hey, Chris.
How many incoming? Five GSWs and two red-bands, milady.
Milady? I'm just trying out a little fresh verbiage from across the pond, what with (British accent): the new dynamic on Alpha Team.
Well, in that case, I prefer "Your Almost-Royal Not-Quite-Highness Zambrano.
" It's not every day your new boss comes with a plate of fish and chips.
MAN (over intercom): Patients are incoming.
Four minutes out.
Do you have to lose your mind to become an attending surgeon here? First Dr.
Rainer waltzes off the job naked as a newborn.
Now, Proctor's upstairs hanging off the side of a building.
Is this normal? No.
Nothing normal about Proctor.
What I can tell, great surgeon, but as a person, slightly left of slightly left of slightly left of center.
Did you get a look at that scar? Mm.
What scar? Sternotomy.
Tissue's still pink.
He had his chest cracked.
And recently, too.
He said he was military, right? Maybe he got fragged.
don't they usually shoot him in the back? (pagers beeping) All right, incoming's two minutes out.
Let's move it.
I'll prep Trauma 1, crash cart, and thoracotomy tray.
Call blood bank.
Let's have plenty of O-neg on standby.
Will do.
Speaking of calls, I got an interesting one this morning.
You're going to make me ask? Headhunter.
Looking for trauma fellows boarded in critical care.
You jumping ship, Chris? What, chief resident isn't enough for you? Well, I'm not thinking of me.
Oh, you trying to get rid of me now? No.
Listen, believe me.
If you leave, I'm the next one out that door.
It's just I think you should've gotten your own team.
Look, I'm a trauma fellow.
Proctor has 15 years of experience on me.
It makes total sense.
Okay, and then what if things don't work out between you and his lordship? You have to agitate, don't you? It's like a disease.
No, I think of it as more of a gift.
Kate Prentice, 23-year-old female.
GSW to the right leg.
She's hypertensive.
BP's 78/40.
We got two liters running wide open.
Where? You're at Miami Trauma 1.
Which means you're about to get the best trauma care in the 48 contiguous states.
And Alaska and Hawaii.
He always forgets Alaska and Hawaii.
I'm Dr.
Deleo.
This is our charge nurse Tuck Brody.
My son Dylan.
He's with his babysitter.
Okay, we'll get all of the babysitter's information and make sure that Dylan's taken care of.
But, right now, we got a sliver of time that'll make a big difference in your recovery, so you lay back, we'll make you better.
DELEO: Kate Prentice, Dr.
Eva Zambrano.
Now, Dr.
Zambrano's going to tell you that she outranks me, but, trust me, I'm a better doctor.
Ready? Let's get her on the table-- one, two, three.
Kate, do you have any medical conditions we should know about? In Insulin.
Diabetic.
Okay, let's get a stat Accu-Chek, and, uh, someone page, Proctor, huh? How's her respiratory status? Uh, breath sounds are clear bilaterally.
And minty fresh.
WOMAN: Sat's 92 and she's hypotensive.
No, thanks.
Never saved a chart before.
You don't want to make the attending's notes? I'd rather get my hands dirty than stand around and supervise.
Okay, we need to get her pressure up.
How long since you were shot, sweetheart? I don't know.
Paramedics reported 20 minutes.
We're going to have to roll you, Kate, and check your back for the bullet entrance.
Now this may hurt a bit.
Hold C-spine.
Ready? (heart monitor beeping) And (screams) Entrance wound.
(groaning) Check for depth and trajectory.
Next chopper is six minutes out.
Should give us plenty of time to get her stabilized.
Probing a little deeper.
(alarm beeping rapidly) We lost her pulse.
Cycle pressure.
V-fib.
She's arresting.
Need paddles.
(defibrillator power whirring) Everybody clear.
(defibrillator zaps) (monitor beeps steadily) She's back in sinus.
Strong pulse.
Okay.
A 23-year-old woman should not be going into V-fib from a bullet that's nowhere near her heart, right? I need a thoracotomy tray.
Let's get our patient's chest open and see why she arrested.
Hold that thought.
I'm sorry? She's back in sinus.
Got good rhythm.
Ultrasound, please, and bolus 150 migs of amiodarone.
Let's stabilize the heart.
She went into cardiac arrest from a gunshot with normal blood count.
That's a heart injury until we prove otherwise.
Which is what we're about to do right now.
(heart monitor beeping steadily) I'm sorry.
I forgot to use my turn signal.
You're right: we will probably have to crack her chest, but let's make sure we exhaust every other option first.
Okay.
(heart beating) No bleeding, no effusion.
Her heart is fine.
How did you know that? BLT.
Is that a is that a drug or a procedure? It's a sandwich.
See, there's an order to things.
You put the bacon on the top with the lettuce in the middle and the tomato on the bottom.
Do you ever try and change the order? No.
Wouldn't taste right.
Point is, if there's a problem with the tomato, then assume you'll find an answer by looking at the bacon.
Got two more incoming.
Both GSWs.
I'll take them.
Get Kate upstairs for an ex-lap.
Page me when you get her abdomen open.
Bacon, lettuce, and tomato? The guy's hungry.
I swear, sometimes, it's like he's speaking in tongues.
He was right about there'd be no cardiac injury, though.
You know, at least with Rayner I always knew what was coming.
We'd be in the middle of a bowel resection, he wouldn't have to say anything.
I just knew.
Three shifts now with Proctor, and still, I have no idea what this man's going to say next.
Me either but I do enjoy it when you say "bowel resection.
" (man groaning) What've we got? Scott Sumner, 32 years old.
Comminuted open femur fracture from GSW, altered mental status.
My leg burns! Burns! Can you hear me, Mr.
Sumner? I need water! Water! Okay, let's get him into Trauma 1.
Check his cap refill and distal pulses.
Make sure he has blood flow to the foot.
I got a 27-year-old female, GSW to the left arm.
BP's 110/70.
Motor and sensory exam intact.
Pressure's good.
Wound is distal and she's stable? You're new, right? We do trauma only; penetrating injuries to the head or torso.
Low BP, diffusive abdominal pain, falls over 15 feet.
You get the picture? We do golden hour.
That's circling the drain, meet your maker.
If they're not dying right now, then they go to the regular ER, which is outside and around the corner.
Come back by after your shift.
I'll introduce you to the killer cafe cubano at our coffee cart.
I gotta get to the O.
R.
So can you? Stem the bleeding on the drunk and do a full trauma workup.
Yeah.
And? Page Ortho and set up a consult, but Is there a problem? No.
It's just I've never really done a case solo before.
Okay, so get him stabilized and page me if you get into trouble.
Page me two minutes before she gets into trouble.
You got it.
All right, let's find the source of Kate's V-fib and get her closed up again.
If you can retract the muscle for me, please? Thank you.
Hang on.
Looks like the bullet nicked her kidney.
If I could just reposition to get a better look.
(alarm beeping) Tachy 175.
BP: 245/115.
Still nowhere near her heart.
Everyone freeze.
(alarm stops) Wait.
Wait.
Look.
What? Right there on top of the kidney.
Some kind of mass.
Looks adrenal.
It's small.
Doubt if it's even been diagnosed.
Adrenal tumor.
How cool is that? Cool? Okay, think-- how would that type of tumor present Come on.
Excessive sweating, elevated heart rate, pressure, tingling in her hands and feet The tumor's causing her diabetes.
It'd certainly explain her diabetic symptoms.
If we could just get down to the retroperitoneal space and get a better (alarm beeping) The tumor's sitting on top of the adrenal gland, which means that every time we touch it We're dumping adrenaline back into her system, cranking her heart rate up from zero to cardiac arrest.
So if we don't fix the kidney and she eventually bleeds to death, or we do fix the kidney and we risk triggering a fatal heart rhythm.
Ain't that a hornet's nest? Okay, Chris, get her to C for a metastatic workup.
I want to see if that tumor is cancerous.
I'm on it.
Eva, get her lacs back stat.
I want to know what we're dealing with before that kidney hemorrhages again.
(groaning) Water! I need water! You're getting I.
V.
fluids right now, sir.
We need to make sure you're stable so we can fix your leg.
Let me up! Let me up! I'm fine! Hey, hey! Go ahead, Dr.
Warren.
Have you taken anything, sir, besides alcohol? (mumbles) What was that? (mumbling) Can you repeat that? Let me go! Can we get some restraints? (yelling, muttering) Who's in charge here? Me.
I got paged to come down for an Ortho consult.
Yeah, uh, bleeding stopped with pressure, BP's stable, but I'm concerned about the patient's altered mental status.
Of course he's altered.
He's drunk off his ass.
Could be alcohol-related, but there's also a chance it may be metabolic or from head trauma.
What are you, like, 12 years old? I'm first year trauma resident.
Well, this is my 20th year as an attending orthopedic surgeon, and my job is to make sure that man doesn't lose his leg.
I understand that, but he's not ready.
You got "residentitis," Dr.
Warren.
You're fishing for an exotic diagnosis.
This one's just drunk.
You'll learn.
Prep the patient.
Move him to O.
R.
3 and page Anesthesiology.
Patient's name is Kate Prentice-- P-R-E-N-T-I-C-E.
Test for catecholamines and metanephrines.
We're trying to I.
D.
her tumor.
Page me as soon as you get the results back.
Thank you.
Excuse me.
Uh, Kate Prentice-- you her doctor? Are you family? Friend from work.
I brought her purse.
Thought she might need it.
Is she, uh is she going to make it? We're doing everything we can.
They still haven't caught whoever shot her, have they? (P.
A.
beeps) (purse thuds) WOMAN (over PA): Paging Dr.
Bender Your arm okay? Sure.
Why? You dropped the purse.
I did.
Has anyone looked at your eye? No, I'm fine.
I just got into a fight with a drunk guest.
When was this? Right before the shooting.
Mind standing still for a minute? Okay.
Um, sir, you need to sit down.
What for? I think you've been shot in the back of the neck.
Oh, no, I haven't.
Can you do me a favor? Can you look right? Come on Now left.
This is I need a gurney here! I can't move my arm! Okay, okay, just relax.
It's Eddie, right? Eddie Del Valle.
Okay, Eddie.
I'm Dr.
Zambrano, and this is our lift team.
What's wrong with me? You've been shot.
Shot?! Without even knowing? You'd be surprised how often it happens.
Now, I think the I think the bullet is pressing against your spinal cord.
So every time you turn your head, it's causing a temporary loss of function in your arm.
Loss of what?! No! No, no.
No, no, no, no.
Stay calm.
Eddie, it's temporary now, No! No! but it can become permanent if you move too much, okay? (speaking Spanish) Eddie! C?mate.
Okay, Eddie! C?mate, c?mate, okay? No te muevas.
Okay.
Okay No te muevas.
Roll him.
Eddie, where are you from, huh? Where's home? Born in Cuba.
Yeah Me, too.
What part? Holgu?.
I've never been there.
What's it like? Beautiful.
Beaches, white sand.
I was born in Havana.
I left when I was six.
Okay, lift him.
One, two, three.
My mother still lives there.
I send her money every month.
If I'm paralyzed and I lose my job, they're going to take away her house.
Let's make sure the next time you see your mom, in her own house, you can hug her with both arms.
O.
R.
3, get fluids in him and I want him on the table in five minutes.
Dr.
Proctor What happened to you? Huh? Zygomatic arch? Oh, it's nothing.
I wanted to update you on Scott Sumner-- comminuted femur fracture.
Better make it fast.
I got a couple of post-op patients to check in ICU.
Okay, uh, Mr.
Sumner is in surgery.
Ortho took him to repair the fracture, but I still have concerns about his mental state because I wasn't able to finish his workup.
Then why is he in surgery? The orthopedic surgeon wanted to get him upstairs immediately.
Dr.
Warren, um that patient is our responsibility.
Until he's cleared from Trauma, you don't just release him to another doctor.
But he was an attending.
He runs a department.
Not this department, right? What's more important: a doctor's rank or a patient's life? Now, do you still think there's something wrong with your patient? I'm concerned his altered state is something more than just "drunk.
" Fine.
Go and prove it.
DELEO: Kate, the anesthesia from the surgery's going to make you feel groggy for a while.
So, I don't have diabetes? Oh, no, you do have diabetes.
It's just that yours is caused by your tumor.
(laughs groggily) That's a relief.
Shame to think I wasted two years shooting up insulin for nothing.
Well, good news is that once that tumor goes away, so does your diabetes.
Initial scan shows no other masses in your chest or abdomen, so it means your tumor's probably benign.
Oh, so I'm going to be okay? I wouldn't buy your lottery tickets yet, but things could be worse.
(over intercom): Did they catch him? The guy who shot me? It was a guy? What No.
I, I just assumed.
It's scary.
The cops are looking for the shooter.
Oh, my God.
Dylan, my son.
Don't worry, Kate.
We left word at your house.
No, you don't understand.
His dad died when he was two.
I'm all he's got.
You've got to keep me alive, okay? One thing at a time, Kate.
First, we gotta get you stabilized.
Dr.
Deleo? What? That.
Print it for me.
Are these all the labs for the drunk with the leg fracture? It's everything we ordered.
Something's missing.
Want me to call down to the lab, see if they dropped a test? No, it's not the lab.
It's me.
If I don't find the answer, we could lose him.
Anything I can do? Lifeline, phone a friend? Okay, person came in intoxicated with altered mental state, but also showing signs of polydipsia.
Hmm, excessive thirst, screaming for water, right? And according to his initial lab work, he's severely acidotic.
Alcohol intoxication alone shouldn't cause that.
Something else did.
Right.
But what? (sighs) Prep O.
R.
1, have Endrocrine on standby.
Page me in 15.
Excuse me, Dr.
Deleo? Heidi Pelton, Med-Trac Recruitment.
I've left you several messages.
Ah, the headhunter-- right, right.
You're a hard man to track down, but the best ones usually are.
I'm sorry.
I really don't have time to do this right now.
You've come a long way from Lake Wimico.
(chuckles) Okay, so you've done your homework.
So have you.
Top of your class at FSU.
You could have your pick of positions.
Heidi, is it? Mm-hmm.
Heidi, I'm flattered, but I'm not leaving MT 1.
Okay.
Maybe I can change your mind.
Jacksonville Surgical Hospital, Brand-new facility, state-of-the-art O.
R.
suites, looking for top-shelf chief resident.
I'm sorry, but I'm I've been up for 36 hours on call.
I have to jump into this hellacious surgery.
What if you could cut your on-call hours in half? Schedule your own surgeries, double your salary.
My number's on the back, in case you want to discuss the offer.
Eddie Del Valle, your GSW, is up in O.
R.
1 for the bullet removal.
Good.
Get him prepped and the propofol running.
Then page me when he's under.
Hey, I got to find Proctor.
Have you seen him? Just got a page.
He wants us both on the roof.
The roof? What Do we do we have more incoming? No.
I just think better outdoors.
Clears the mind.
Is he eating a BLT? Uh What'd you find? Bullet hit the renal hilum.
We didn't see it before.
It's only a matter of time before the whole kidney ruptures and she bleeds out.
We got to get her into surgery, get that tumor out, fix the kidney.
Yeah, but if we so much as breathe on that tumor, she's going to code.
You think we should wait? I think we should infuse her with alpha-beta blockers to counter the adrenaline.
Let the drugs run 48 hours before we operate.
She has a high-grade kidney laceration.
It's a ticking bomb.
Yeah, but if we operate now, she can die on the table.
And if we don't, then she could die the next time her kid hugs her.
Okay.
Heads we take the tumor now.
Tails we wait 48 hours.
You can't be serious.
Why, you want heads to wait? We can't decide off a coin flip.
Does seem capricious, doesn't it? What's it going to be? We take the tumor now.
After we run alpha-beta blockers for at least an hour.
Excellent compromise.
(elevator bell dings) (pagers beeping) New incoming.
I'll take this one.
Chris and Eva, can you get Kate's meds running? Uh, I got O.
R.
2 with my GSW to the neck.
Fine, Chris can prep.
Page you when I'm ready.
Maybe you can page her from upstate.
'Cause I hear the, uh, weather is lovely in Jacksonville this time of year.
What? Jacksonville.
You know, the river city.
Home to the second largest jazz festival in America.
First inhabited by the Timucua Indians over 6,000 years ago.
You know if you're looking for a stress-free job, I do know of a recently vacated position in a GI practice in Maryland.
(laughs) Not really sure what you mean.
No? No.
But then I'm not a beautiful blonde with a glossy brochure, am I? (monitors beeping steadily) All right, Eddie, let's make it so you can go see your mommy in Cuba.
No more bullet.
If you'll close, I'm going to fight to get Eddie a bed in the crowded ICU.
(chuckles) Uh, whatever you're looking for, I'm sure there's a nicer place to find it.
(sighs) Trust me, I'd much rather be poolside in South Beach right now.
Except for the crazed gunman who's on the loose.
They haven't caught him yet? Police are still looking.
It's really scary.
Everything okay? (sighs) Considering I've been punched in the face, had a patient stolen from me by an attending, and now I'm Dumpster-diving for medical evidence, best day in the history of residency.
Who stole your patient? I think his name was Kaye.
As in Angry Ortho? He accused me of residentitis.
Yeah, well, Kaye's a rite of passage around here.
Everyone has a run-in with him at some point.
Trick is to anticipate him.
Get inside his head.
How do you do that? I'm the wrong person to ask.
The way things have been going with Proctor lately, I What's he doing now? Uh, holding consults on the roof, flipping coins, eating deli sandwiches.
What are you looking for, anyway? Wish I knew.
Scott Sumner, drunk GSW from the hotel shooting, his labs are all over the place.
How do you figure out what's wrong with a patient you can't have access to? Process of elimination.
(sighs) What goes in has to come out.
Greg Wilson, male, GSW to the face.
Arrested en route, unable to intubate in the field.
Another gunshot victim? Self-inflicted.
Cops chased him down Ocean Drive, tried to kill himself before he got arrested.
PROCTOR: Why were they chasing him? Because he's our hotel shooter.
(engine roaring) (monitor beeping rapidly) No pulse.
He's in asystole.
Continue CPR.
I'll find an airway.
(alarm beeping) (flatline tone sounding) (suction slurping) Not much of his face left.
We're going to have to cric him.
(flatline tone continues) Scalpel.
4.
0 trach tube.
I'm in.
Can we get some hands in here? (groggily): Have-have you been able to reach my son? Babysitter's on her way.
No, but I don't want to go under before I see Dylan.
Can't we can't we wait? Every minute we wait is a greater chance that your kidney could rupture.
So we got to get that tumor out.
We got to stop the bleeding.
And then we'll deal with the bullet.
You stopped joking with me.
What do you mean? That just from the moment I've arrived, you've been making me laugh.
I guess the end of the jokes means things have gotten pretty bad.
(elevator bell dings) Mommy! Hey! Peanut! Oh, I'm so glad you're here.
Epi's in.
Hold compressions.
Still asystolic.
Resume CPR.
Another mig of atropine.
Dr.
Proctor.
He's leaking brain matter.
There's nothing more we can do.
I'm calling it.
Time of death: 15:33.
(flatline tone stops) I'll call down to the morgue.
(groans) That hurt? My neck's killing me.
I think I need more pain meds.
You got two milligrams of oral Dilaudid.
And two more now before that.
I guess it's not working.
Let me ask you, did you take those with milk or apple juice? I don't know.
Why? 'Cause the malic acid in the juice can blunt the drug's effectiveness.
(sighs) I think it was with apple juice.
That's interesting.
'Cause I just made that up.
And since there's no apple juice in your trash, and this hasn't been opened, Eddie, have you been cheeking your meds? What No.
Eddie.
(sighs) They're for my mom.
(sighs) Her ulcer's hurting her real bad.
Been sending her money for pain meds, but she can't buy 'em.
Why not? It's Cuba.
Where there's never enough of anything.
I was just trying to help her.
And I figured a little pain ain't going to kill-- (gasps) All right, I'm putting you on I.
V.
pain medication from now on.
No more orals.
(sighs) Alpha-beta blockers are running.
You ready? So if this goes well, no more diabetes, no more tumor, no bullet.
Like a do-over, right? This is just like a do-over.
Okay, listen, I need you to get her under.
Page Dr.
Zambrano for me.
All right? Tuck.
Went back through the drunk guy's labs to eliminate causes acidosis-- nothing, right? Then I went through the trash bin in Trauma 2.
Found this.
What do you see? This a trick question? Ethylene glycol poisoning causes urine to glow.
That explains the acidosis, the altered mental state I don't know how it got in his system.
Ethylene glycol, as in antifreeze? Yeah.
Why? A serious drunk can get rid of the shakes with a couple of sips.
Wait, he was drinking antifreeze? Wouldn't be the first I've heard of it.
(pagers beeping) "Code Blue, O.
R.
3.
" Hey, isn't that your patient? Clear! Still V-fib.
Push another 150 milligrams of Amiodarone.
Prepare to shock again.
Everybody take a step back.
We're going to bolus him three amps of bicarb, and run this antizole.
What the hell are you doing? Trying to save my patient.
You have no standing here.
His labs came back positive for ethylene glycol; he was drinking antifreeze.
Again with the exotic diagnosis.
Labs don't lie, Doctor.
You want to argue or you want to make this man better? Bicarb and antizole are running.
Carotid pulse is strong.
You got him back.
Before you say anything, we both know that was my patient.
Drunk or not, I never cleared him.
But you ignored that and you put his life at risk.
Or maybe you just woke up this morning and decided to ignore the Hippocratic oath.
Dr.
Warren And another thing: I don't care how young I look.
I am a trauma surgeon, and don't you ever forget that.
I was going to say, Dr.
Warren nice work.
Oh.
Thank you.
DELEO: She's starting to bleed into her abdomen.
The kidney's just oozing.
Focus on the tumor.
First, tie the vein from the adrenal gland.
So the adrenaline can't flow back into the heart.
This ain't my first rodeo.
Okay, cowboy.
Get a retractor in.
Easy.
Little more to me.
There (alarm beeps, then stops) Take it slow.
It's like that game, Operation.
Don't touch the sides or (alarm beeping rapidly) (beeping stops) Metzenbaum scissors.
All right, let's get this bad boy out.
Adrenal tumor, 500 points.
All right, let's close now.
She called this her "do-over.
" Who? The patient, Kate Prentice.
You think that's possible? A do-over? Maybe you should ask Proctor.
What do you mean? Well, the guy shows up out of nowhere, big scar on his chest, past he doesn't want to talk about.
Sounds a lot like a guy who's trying to have his own do-over.
(alarm beeping rapidly) Pressure's dropped.
What just happened? Her abdomen's filling with blood-- I need lap pads.
Did you hit the kidney? No, I didn't touch it.
It just blew.
First the bullet, then the tumor, now the kidney.
(monitor beeping rapidly) 2.
0 cro-mig.
And someone page Proctor.
We need him in here now.
What's her status? Got the tumor out.
Kidney blew up like the Hindenburg.
We tried pressure and over-sewing, but she arrested from blood loss.
Did you cross-clamp the aorta? Done, and we got her back.
But when we unclamped, she coded again.
It's like digging a hole in the sand.
I repair one part of the kidney, another one opens up.
Okay here we go.
Let's have a look.
Blimey! Impressive amount of suturing.
Give her two more units now and a vasopressin I.
V.
(alarm beeping) I can feel her heart.
It's fibrillating.
Internal paddles.
Bring her back.
Sutures keep tearing.
Clear.
(defibrillator zaps) Still fib.
Clear.
(power whirs, paddles zap) Her heart's pumping.
She's in sinus.
Okay.
Here we go.
Clamping the renal vessels.
I already tried over-sewing.
Yeah, I can see that.
If I can't fix her kidney, you can't fix it.
So why waste any more time trying to do that? Scalpel.
Wh What are you doing? Sometimes the best way to fix a problem is to eliminate it.
You took the whole kidney.
Good thing she only needs one.
Bovie to me.
See, here's the thing: it's 1991, AIDS evac hospital outside Kuwait City.
I spent four hours pulling shrapnel from a damaged kidney-- tiny, little slivers of metal like, uh well, like human hairs.
And I'm so focused on fixing my patient that I nearly killed him.
So, eventually, my chief steps in and just whips out the whole thing.
You see, the kid's mom wasn't going to count organs when she hugged him.
And neither will this young lady's son.
Eva.
Unclamp the aorta.
(monitor beeping steadily) Vitals are holding steady.
And the field is staying dry.
You mind closing? All right, so, your bullet wound is healing nicely.
No signs of infection and it looks like you're going to go home in a few days.
And one more thing.
Toma.
What's this? My father was a well-respected surgeon in Cuba.
And he still has connections.
I don't understand.
Well, just have your mother call that number.
It's a private clinic in Havana.
They treated Castro's ulcer a few years back.
I, uh (gasps) I don't know what to say.
Just Just send me some photos of Holgu? next time you see your mami.
Okay? Thank you.
Yeah.
You take care.
Dr.
Proctor, you get my page? Frank Wilson, the hotel shooter-- I was going through his clothing.
Found this.
What's that? That's him with Kate-- our waitress, right? Yeah, looks like she knew the guy.
So, who was he? Don't know.
The police are still trying to figure it out.
But whoever he was, he wanted Kate dead.
(knocking twice) You're going to be here a few more weeks.
But, um, as soon as we release you, we're expecting you to make a full recovery.
So I would say that now's probably a good time to buy those lottery tickets.
(both laugh quietly) You're joking again.
Yep.
That's a good sign, right? And want you up and out of this bed as soon as possible.
I don't think I'll have much choice.
It hurts when I breathe.
PROCTOR: That's normal when you've had your chest cracked.
It's nothing permanent.
It should go away in a couple of months.
You, um you might have a hard time sleeping.
Not through anything physical, but, uh It's hard.
Yeah, the police were here earlier.
They told me about Frank.
The guy who shot you.
My ex-boyfriend.
I had a restraining order against him in Georgia.
I had no idea that he followed me here.
You don't have to worry about him anymore.
I guess I get my do-over.
Yeah.
I guess you do.
Quiet up your mind and let me in DELEO: This thing presents itself as a simple GSW, and ends up a total nephrectomy on top of an adrenal tumor.
It's unbelievable.
You know, right before Proctor took the kidney Yeah? I knew exactly what he was going to do.
Really? Mm-hmm.
I'm not sure how, but I just knew.
(imitating Yoda): Hmm, progress you are making.
More powerful you have become.
Okay, dork you are.
Yeah.
See you tomorrow.
Okay, see ya.
I know it's hard to get to know your pain You try to hide it over again But that only puts you deep down Jacksonville.
What's a hard time? You told Kate, "You might have a hard time sleeping.
Not from anything physical"" I know it's hard to lay it all down And feel the world all around you That's the only way, that's the only way I The scar on your chest-- what happened to you? 88 seconds.
What? I was coded, right? I was flatlined.
Time of death called.
I was gone for for 88 seconds.
My do-over.
Dr.
Proctor Have you ever noticed, at this time of the evening, just before the sun goes down, how the light seems to kind of just drip towards the horizon? So softer now Softer now.