Miami Medical (2010) s01e08 Episode Script

Oh, not bad for a girl.
A girl off the men's tee, Brad.
Ignore him, Lucy, he's just jealous.
Whoa, was anyone complaining when they set us up with a girl? Actually, yes.
Something about her killing your mojo.
Thanks.
What are you, like 17? Only for another 11 hours or so.
This is an early birthday present from my folks.
Want to give it a try? Looking a little whipped today, Ry-boy.
Long night.
Barely got three hours of sleep.
Not me.
Slept like a free man.
No kids, no headaches.
No ball and chain.
Yeah, no nothing that matters, right? Okay, guys.
Keep the Vanessa stuff off the course, all right? Fine by me.
Just hit the ball already.
Come on.
That's terrible.
Just when you thought a bad shot couldn't get any worse.
Oh, he's had worse.
In the water.
In the water.
The water.
All right.
I should take the drop.
What, are you kidding? Dropping is for Girls? Sissies.
I was gonna say sissies.
Mm-hmm.
Ooh that is nasty.
Just hit it.
Staring at it's not going to improve the line, Ryan.
Are you okay? Ryan! Alligator! Ryan! Grab my hand! Ryan! Grab my hand! Grab my hand! Grab my hand! Ryan! Elroy, hit him! Grab my hand! Ryan! Ryan! Ryan! Ryan? Ryan?! Am I reading this right? "Alligator attack at Palm Drive Country Club"? Last I heard, it was five minutes out.
What's this? Tickets to The Black Eyed Peas? Tonight? Oh, my pneumo from a couple weeks ago.
He wanted to thank me.
Oh, I love The Black Eyed Peas.
Where did you score those? They're Eva's.
She was just about to invite me along.
Huh.
And why would she take you when she could take me? Huh.
- I saw The Black Eyed Peas in Boston two years ago.
Got a call to go backstage when Fergie got food poisoning.
Will.
i.
am will have to be put on hold.
Gator victim's on our doorstep.
I will pick up your dry cleaning for a month.
No, no, no, I will wash your car and a neck massage.
Hmm.
Ryan Whitten.
28-year-old male.
Right foot amputation and lacerated femoral artery.
Abdominal trauma, altered mental status and respiratory distress.
GCS is 4-6-4, tachy and hypotensive.
I was standing there and then my foot was just gone.
We'll get you stabilized first, Ryan, then we'll deal with the foot.
Did they recover it? The foot! Haven't found it on scene.
- Whoa, whoa, whoa, hey.
- Hey.
Uh, we're Ryan's friends.
Brad Dalton.
Elroy Hindley.
We were-we were with him.
The gator-- had to weigh, like, 500 pounds.
Yeah, he dragged him in the pond and held him under.
How long was he underwater? Two, three minutes.
Wasn't breathing when we pulled him out.
Why don't you tell everything to one of our nurses.
Yeah, and then do not pass go, do not collect $200, you're gonna go straight to the ER, get these injuries checked.
What, this isn't the ER? No, this is MT1.
It's trauma only.
ER's around the corner.
We're gonna stay with Ryan.
No, no, no, no, you're gonna go through those doors, around the corner and to your right.
Just Do not make me continue with the monopoly references, Brad.
We'll be right back.
Great.
Lucy Reyes, multiple lacs to head and arms with blunt head trauma.
All right, Lucy, can you tell me where you're feeling any pain? My head.
Everything's spinning.
Let's finish a primary survey, get her a head CT.
Oh, and, uh Next of kin? Her parents.
Got a cell phone number for her father.
Good work, Kleebus.
Ow, my leg! It's throbbing.
One milligram of Dilaudid.
We're gonna give you something to take the pain away, Ryan.
You just drift off to sleep, okay? I'll take the femoral artery.
Check his lungs.
I need some help-- he's bleeding out.
Grab me a stack of four by fours and two units on the rapid infuser.
Pressure's still dropping.
Should I call up to O.
R.
? He's not gonna make it unless we stop the bleeding.
They found the foot; golf course security's bringing it in.
Excellent! We'll stop the hemorrhage.
Serena, go and get that foot ice.
Where is it? Here's your perp.
Complete with the stolen goods inside.
You mean the foot is inside there? Mm-hmm.
Oh, we dredged the pond.
There was only one gator, so So you shot it? You'd prefer him alive? Okay Let's get the gator on a gurney.
Ali Gator, age and sex unknown.
GSW to the right flank, possible esophageal reflux from ingesting a human foot.
Tell Eva to page us when Ryan, our foot amputee, is stabilized.
Want me to And miss the chance of a lifetime, are you kidding? There's quite a bit of tough abdominal muscle to get through here.
What's this Must've been midday snack.
Lucky for Ryan.
Force of their bite is 2,000 pounds per square inch.
Great.
This feels like bone.
I'll find Zambrano, if you, uh Contact the on-call vascular surgeon for a consult.
If it's viable, we're gonna have to act fast.
Thank you.
Hey, there, Lucy.
Sweetheart? Dad.
Mom's trying to get a flight back from Chicago.
Okay.
I'm just gonna ask you a few questions and then you can get some more rest.
You still feeling dizzy? Um, no, I'm just really tired.
That's normal with head trauma.
How about any nausea or blurry vision? No, not really.
Well, her head CT shows no bleeding in her brain, so Thank God.
Yeah.
How soon can I practice again? You take it easy-- let's let's get you checked out before you start setting tee times.
She has a golf scholarship.
A full ride to Stanford.
Really? Yeah.
Pre-season training starts in, like, a month, so Oh, yeah? Have you tried opening up your grip? Mmm.
If you just, uh, don't wrap your right thumb over your left so much, then Was, um, was this redness here before you got those cuts? Um I guess so.
I have pretty sensitive skin.
It could be that new sunblock, Luce.
Let's get them checked out just to be sure.
Uh, let's get a tissue sample, send it up to the lab.
That's it.
I'll come back once we get the results.
Great.
Thank you.
Uh, open up my grip? Got it.
Pressure cf stopped the bleed in Ryan's leg.
His femoral artery should hold up until we get him to the O.
R.
How is his breathing? High-flow oxygen seems to be helping.
Doesn't appear to have aspirated water.
That's unusual, considering he was underwater for three minutes.
Ryan's wife just arrived.
And wee got an O.
R.
scheduled for an hour from now.
Vascular consult's on the way.
All right, let's Ryan a chest C to check for any delayed lung swelling.
Run another set of blood work and prep him for the foot replant.
I'll take the Fe.
Not if you want to see The Black Eyed Peas.
How about I do all the blood work, oversee O.
R.
prep, and buy all the food, drinks and souvenirs your heart desires? Better.
I'll take the wife.
Are you Ryan's wife? Yes, Vanessa Whitten.
Hi, I'm-I'm Dr.
Zambrano.
I'm afraid your husband's in critical condition.
He was having difficulty breathing.
But it seems to be resolving now.
I can't believe this is happening.
The good news is that we were able to stem the bleeding in his femoral artery.
And how about his foot? They recovered it.
We're just checking to see if it's viable for reattachment surgery.
So that's good, right? It's better than the alternative, yes.
Aren't you supposed to be in the ER? Oh, dude, I told you the hot doctor was gonna be pissed if we hung around.
I'm fine.
He won't go, Doc-- he doesn't think I could handle this.
I'm sting, Vanessa.
Hey, who wants to get a coffee? Maybe a latte? You and your stupid golf game.
What does this have to do with golf? He even took an earlier flight for you, Elroy.
Yeah, he got bit by an alligator because he took an earlier flight.
That makes a lot of sense.
You know what, not everyone can live like they're still in college, Elroy! Do you think I wanted him to end up here?! Hey! I'm his best friend! Yeah, you know what, I'm his wife! Elroy! Okay, okay! Tensions are high.
I need you two to calm down.
For Ryan.
He has complicated surgeries ahead of him.
Elroy and I are absolutely gonna go get that drink now.
Okay.
It's gonna be decaf.
I'll come find you if I have any updates, okay? Alligator made a clean cut through the major vessels.
The foot looks remarkably good.
Especially considering they pack about 2,000 pounds of bite force.
You're a closet herpetologist? I got it from Proctor.
Mmm.
Quite a mind on that one.
Is Vascular here yet? Dr.
Sable.
You're not Vascular.
You're Cardio.
Actual, I'm both.
No one's both, not anymore.
Cal Berkeley and U Penn may disagree.
Is the foot viable? I'd say we have a good shot at replantation.
How's the patient? I tied off his femoral artery.
Though not perhaps with the elegance of someone of your expertise Oh, I'm sure you make up for it in other ways.
Should I go do something? Get the foot prepped and take Ito the O.
R.
Dinner, Nobu, one hour after your shift ends.
What if it's 8:00 in the morning? Breakfast at the Brick House.
And if it turns into lunch, Tony's on Palmdale Drive.
You think of everything.
Yes, I do.
Doctor Deleo.
See you in the O.
R.
Looking forward to it.
What's up? My golfer, Lucy Reyes, she has a redness spreading up her arm.
Thought it was cellulitis but Doesn't appear to be simple cellulitis.
Looks more like a vibrio infection.
And it looks like it's spreading to her deep tissue.
That's necrotizing fascinitis.
Flesh-eating bacteria.
If she got this in the pond, that means the other patients are at risk, too.
Okay, turn over.
What's that for? To help us track the rate of bacterial growth.
So, it's getting worse? It's developed into something called, uh, necrotizing fasciitis.
I saw that on the news.
That's flesh-eating bacteria? Oh, my God, flesh-eating? It's not-it's not literally eating, Lucy, but it is causing the destruction of the underlying tissues in your arm.
Do the others have it? Not so far.
Not everybody who's exposed to it gets infected.
What do we do? First we try debriding.
Cutting away the infected tissue.
But the chance of that actually stopping the spreading of it are about 20 percent.
And if it keeps spreading? If it gets into her blood, then it could cause something known as sepsis.
Um, now, once that happens, it will shut down your vital organs.
The only sure way to completely eliminate the bacteria is amputation of the limb.
What? No, no.
And that's only as a last resort, Lucy.
You're not cutting off my arm.
Let the doctor speak, sweetie.
No, I don't care what you have to do.
If there's a 20 percent chance to save it, just We're gonna do whatever we need to do to get you through this.
That's not your call! Let's just listen.
No, I'm an adult now, okay, or I will be in, like, six hours, and this is my body.
You can't tell me what to do with that.
Lucy, Mr.
Reyes, I understand.
It's a lot to absorb, but at the moment, hard as it may sound, I just need you to be patient until the biopsy results come in.
Then we decide how to proceed.
Together.
Okay? Good news, Ryan.
Your chest CT looks no so we're gonna prep you for the O.
R.
My wife, Vanessa? Here.
She's in the waiting area with your friends.
Not to worry.
I've been updating her on your condition.
Can you, uh, take him up to the ICU and page me when the O.
R.
's ready? Great.
I'll see you soon.
Clam chowder or chicken with stars? Oh, first, I have a rule about taking soup from strangers.
Really? Mm-hmm.
And second, why aren't you still the ER? Well, yeah, I had to use my ninja moves to get Elroy there.
But then I claimed I had to go to the bathroom so I could go check on Vanessa.
Mmm.
Those two-- it's like fire and ice.
Yeah, I noticed.
Must be hard running interference.
We've en tight since college.
Elroy took it kind of personally when Vanessa AR.
Started calling her Yoko.
She broke up the Fab Three? Whoa, you mean Fab One.
Those two, they're well, they're all right.
Are you flirting with me? The soup offering might've been flirting.
But the, uh, the banter, it's just keeping the communication open.
In hopes that if something does happen, you'll come to me first.
That way I can manage fire and ice.
Sounds like a solid plan.
I'll see you in bit.
What about our soup date? I have lives to save.
Get back to the ER.
Consider it a rain check.
I'm going to talk to him, okay? Hey, Dr.
Deleo? If-if there's any chance that you have to amputate to save her life, you gotta promise me that you'll do it.
I'm going to do what's best for your daughter, Mr.
Reyes.
Yeah, but after midnight, she's an adult.
Which means the decision becomes hers.
Now, I can already see Mr.
Reyes No, it's all gonna be about her golf.
It's-it's the great love of her life.
Legally, things may change because of the birthday but emotionally, she's still just a kid.
She is too young realize that she's mortal.
If this were your daughter Lynn Lucy Reyes-- do you have the biopsy results yet? Just got off the phone th the lab-- they're running behind.
Ok, I need to book an O.
R.
before midnight in case I need to do an arm amputation.
I'll see what I can do.
No, no, see-see-e isn't gonna work.
Must be fore midnight, and ll the lab I needed those results yesterday.
Got it.
I got six hours to save her arm.
Lunch? Uh, for the gator.
Ryan Whitten's foot-- If the foot's out of the gator, why am I still looking at that.
Fish and Wildlife have to come get it.
Make sure it's not tagged or protected or something.
Well, they better hurry before Chatty Kathy makes herself a belt and a new pair of pumps.
Where you headed? Uh Well, Ry's CT was clear, so I'm gonna update his wife.
're so not making it to that concert, are we? At this pot, not likely.
Best show you ever saw? Hmm, Chili Peppers.
Drove all day to see them in Tallahassee.
Daft Punk Lollapaoza.
Grant Park when I was at the University of Chicago.
Head bouncing, hands in t air all sweaty fr the humidity.
What? Oh, yeah.
Hi, Kathy.
Hi, Kathy.
I got your page.
I have a problem.
You have my bike.
Oh, I figured if repetitive motion works for you, I'm willing to give it a try.
This about the golfer girl? I have exactly five hours and 44 minutes to decide whether or not to amputate Lucy Reyes' arm.
You started debriding? I don't want to cut too much tissue without knowing how deep the infection's spread That's all you can do.
Yeah, but Lucy turns at midnight.
So, up until that point, the medical decisions rest with her dad.
But once that clock strikes 12:00 It's up to Lucy.
Yeah, and her dad's afraid she's gonna wait too long to make the call.
So, in the meantime, I have to figure out what I can do to save her life, her arm, and a relationship with her father.
Give me the bike.
Really? You want my help, give me the bi.
I assume you've got her started on broad-spectrum antibiotics.
Yeah, from the moment she was diagnosed.
But it doesn't seem to be slowing the infection.
Any sign of lactic acid Came back normal.
Good.
That points away from sepsis.
You should get hold of a near-infrared spectroscope.
Would that work? I've only heard of them being used to check brain function through the skull.
Can also measure O2 levels in deep tissue.
You'll be able to see where and how much of Lucy's arm is still getting oxygen, and how much more tissue to debride.
That's right.
That's the bike.
And that's my O.
R.
ready for OT reattachment.
Hey, thanks.
"Hope for the best, prepare for the worst.
" Smart lady.
She also used to say, "Put things back where you found them.
" Nice work on his femoral artery.
I managed to stop the bleeding.
Looks like our dinner's become breakfast.
Foot's ready for replant.
Keep it on ice.
Ryan's artery isn't supplying blood to his lower leg.
Leaving us nothing to attach the foot to.
It'll merely delay things until we do a bypass procedure.
Which, unfortunately, will have to wait.
I have an emergency aortic transection to attend to.
Torn aorta trumps severed foot every time.
Only for an hour or so.
Now what? What if the leg's not viable in an hour or so? Ever read Frankenstein? I saw Young Frankenstein.
Close enough.
We're gonna need surgical tubing and vascular loops.
I'm not sure I follow you.
We're gonna run blood through the tube to his lower leg until Dr.
Sable can do a formal repair.
External bypass.
That's like "Franken-leg.
" Franken-sort-of.
Vanessa? How's Ryan? He's doing well.
Uh, his chest CT came back clear and now he's up in the O.
R.
, ready for his foot reattachment surgery.
Thank God.
Uh, listen, I wanted to say sorry for the little fight Elroy and I had.
We've um, never really seen eye-to-eye.
Yeah, I-I got that.
Brad's been such a saint, keeping Elroy from driving me nuts.
Brad? Mr.
Dalton? Wake up.
What? Can you stand up? Wait, what's wrong with him? What is this? You got a bump back here.
Did he hit his head? I don't know.
He didn't mention anything.
I need a gurney out here! If I'd have known there was a bed involved, I would've brought my own blankie and stuffed animal.
I'm gonna take I'm gonna take a little nap.
No.
No, no.
You stay with me, Brad.
Okay.
Okay? How did you end up with that bump on your head? Gator wrestling.
Huh.
I showed that thing who's boss.
Do you remember blacking out? Now that you mention it, I do remember having a little headache.
But it it was no big deal.
Tough guy, huh? I am tough.
I'm sweet though.
Hey, Doc? Yeah.
Anybody ever propose to you in this thing? Uh, happens at least once a week.
He's starting to herniate his brain.
Call Dr.
Chung in Neurosurge.
I bet we could make it work.
I prob I probably should get you a little cup of soup.
Brad?! Brad? Brad! Stay with me.
Brad! He's posturing.
Get me a crash cart and burr hole kit.
Hurry! I managed to evacuate the clog, but there's massive brain injury.
Come on, Brad, don't give up.
Keep fighting.
I'm sorry to say, you're asking a lot.
There was too much damage.
What, uh That's a delayed bleed in the skull caused by hitting his head.
We tried to relieve the pressure, but he didn't make it.
He didn't make it? He died? We got to him too late.
I'm sorry.
What? He-he-he was just totally fine.
I mean, he didn't complain of a headache or nothing.
I can't believe this.
I mean, he was-he was just standing right here.
I'll be back to check on you both when I have some news on Ryan.
All right, we're gonna need a scalpel and, uh, Lidocaine with epi.
Wh-what are you doing? I'm cutting away some of the infected tissue, try and stop the infection from spreading.
Hopefully this will buy us some time until we can get into an O.
R.
Wait, an O.
R.
? I can do a full debridement there and, uh, and I can cut deeper.
You're gonna feel some pressure.
I want you to let me know if you feel any pain.
My dad-- has he been telling you to amputate? Just trying to make sure we don't let this thing get into your blood.
Yeah, but he's not the one that has to live with the decision, I am.
I've wanted to be on the Stanford golf team for since I was, like, ten years old.
I just don't understand it.
I should be able to make my own decision, okay? Lucy I mean, one hour from now, on one side of a second, my dad is in charge and on the other, I am.
I mean, what changes in that one second? You know, I-I don't know.
But we're gonna keep fighting so we don't ever have to get there.
All right? Yeah.
How are we doing on Ryan's popliteal artery? Tying off the last suture right now.
Good.
This should restore circulation to his foot.
Let's give it a try.
Blood seems to be flowing.
Yeah.
And the leg is pinking up.
This is amazing.
Like nothing they teach you in med school.
Doesn't seem to be any leakage.
That's a nice job.
Zame to you, Herr Fronkenshteen.
Teri Garr, Young Frankenstein.
I prefer the classics.
Boris Karloff? The Munsters.
You can take Ryan to ICU.
I'll see if I can track down Dr.
Sable.
You did your own bypass.
The only asset more valuable in the army than speed is creativity.
Hmm, I like a man with imagination.
It's not bad.
The shunt is crude but clearly effective.
Are we good for reattachment? I'm all yours.
Excellent.
Of course, I'll need you to assist.
I'd hate to mess with your shunt without you.
My crude shunt.
No slight.
I was just hoping you wouldn't proceed without me.
I've been proceeding without you for my entire life.
In fact, if I'd waited any longer, the chance of reattaching the foot would've been made much worse.
Hmm.
You know, I don't think I don't think we're gonna make breakfast.
We won't make it out in time? No, it's not that.
It's, um You're more me than I am, if that makes sense.
And, uh, as much as I quite like the idea of dating myself, it's a little weird.
So, where does that leave us? You're just gonna have to wait for me to ask you out.
Dr.
Deleo, it's getting late.
I'm aware of that, Mr.
Reyes.
My O.
R.
time got pushed.
What does that mean? You promised me.
No, no, no, what I promised you, sir, is that I would do everything I could to save your daughter's life.
He's not taking my arm, Dad.
Lucy, I'm sorry but this is not about golf or Stanford anymore.
This is your life.
I know that.
Now, you have always pushed yourself to be the best at everything, you are so strong, but you're not invincible.
What are you gonna do? Yeah, what? I'm taking her to surgery.
Let get her arm on an arm board and prepped with Betadine.
Hang another bag of antibiotics.
The room's ready for you, Doctor.
Dr.
Deleo? Everyone just stop.
You're running out of time.
What is that? Happy Birthday, Lucy.
I knew you were on my side.
Hey, of course I'm on your side.
Which is why I have to tell you that we need to amputate your arm.
I thought you'd try to save my arm no matter what.
I did.
But if we amputate, you can have a long and rewarding life.
But if we don't, there's a chance that that infection will spread, and once it does, you will die.
Why can't you try the debriding thing first? I don't care how much you cut out.
Listen, Lucy No, I don't get it.
If you thought I should amputate, why did you wait? Because I wanted this to be your decision.
Not one you can blame on your dad for the rest of your life.
So it's all up to me now.
So, what'll it be? Heard about your patient, Brad.
I'm sorry.
He offered me soup.
You know why getting The Black Eyed Peas tickets made me so happy? I just want one night where the weight of life and death isn't hanging in the balance, and I'm Singing out loud? Yeah.
Under e stars, not a care in the world.
Let's go, Doctors.
I'm ready.
Let's reattach the foot.
I need some singing.
Lucy did well.
Oh, my God, you didn't do it, did you? You let her decide even after I begged you Mr.
Reyes.
Luce, Luce, sweetie, I'm right here.
You did it? She did it.
It was her call.
My baby girl.
She's a fighter.
Yeah, she is.
She never she never ever gives up.
Okay.
Luckily, we were able to save her shoulder to make it easier for fitting a prosthetic arm.
Soup from, uh, from the health food place.
Thanks.
Have you ever heard of the luminescent jellyfish off Key Largo? No.
It's migration season.
The surf just glows.
If we left now, we could be on the beach while it was still dark and get breakfast on the way back.
Are you asking me out? I am, yes.
How unexpected.
I'm going to have to think about it.
Really? Well, it's just so sudden.
I'm worried you might be moving a little fast.
I'll drive.
No, you won't.
You won't buy breakfast, either.
Right.
Work it.
Own it.
- Work it! - Own it! What? Oh, my God.
What are you guys doing? We know you didn't get too to the Peas, so Well, give me a break.
It's 3:00 a.
m.
It's all I could get my hands on.
Well, I guess warm beer is better than no beer, right? I raided the vending machine.
HM Ding Dongs? Ah, you guys.
Gummi worms? Sure.
And then, there was singing.
Come on! Oh.
Here it is.
What is this? Whoo!