Monday Mornings (2013) s01e08 Episode Script

1 Hey.
Hey.
Listen, uh, I got sued.
What? Why? Well, not malpractice.
Please don't tell me.
Yeah, interference with marital relations.
And, uh, how's this? Your husband hired Mitch Tompkins.
Excuse me? Right, let's get started, shall we? Dr.
Delany.
Perhaps you'd like to tell us what you've done.
Allison Cabrera, 17 years old, admitted Monday for a otoplasty and tympanoplasty.
Oh, I don't fancy these procedures with the longer names.
Was it dangerous, doctor? No, it was fairly routine.
We were just removing some scar tissue from in and behind the left ear.
Excellent.
And did it go routinely? No.
No? I don't think I like the sound of that.
The patient was given an injection of Lidocaine with 1 in 100,000 epinephrine.
Her heart rate and blood pressure spiked.
We brought it down, and she stabilized.
And Oh, I'm so sorry.
Please, continue.
10 minutes after stabilizing, the patient went into cardiac arrest.
Full cpr was initiated.
Resuscitation attempts failed.
She died.
Yes.
Young woman comes in for a routine surgery.
What was the cause of her scar tissue, by the way? A dog bite.
- She was bitten by a dog.
- Yes.
- What kind of a dog? - I I believe it was a bichon frisé.
Oh, a little dog.
So she comes to us with scar tissue from a little nip on her ear from a bichon frisé, and now she's dead.
At first, we thought the patient had reacted to the Lidocaine.
It turns out she was given 3 milligrams of epinephrine 1 in 1,000 instead of lidocaine with epinephrine 1 in 100,000.
She was injected with a lethal dose of adrenaline.
Yes.
Could you tell us how that could possibly occur? Well, the medications are typically poured into sterile cups, then drawn into syringes.
Somehow pure epinephrine was mistakenly poured into a cup labeled "Lidocaine with epinephrine.
" Who made that mistake? My circulating nurse.
And who delivered the kill shot into the child's ear? My resident.
Dr.
Delany, are you familiar with the "Captain of the ship" doctrine? Yes.
Please, tell us what that is.
It basically means that the surgeon is responsible for any negligence that occurs in the O.
R.
- And that would be you.
- That would be me.
And what steps, doctor, have you taken as a result of this monumental Not to mention despicable Gaffe? Well, I'm I'm still investigating the incident.
This only happened yesterday.
I've, uh, met with the scrub nurse, the circulating nurse, the anesthesiologist, the resident, retracing every single step to - So you're playing it backwards.
- Yes, all the way back to the trash, where the vials were found, and the mix-up was clear.
And what have you ascertained thus far? Once the medications were transferred to the cups, it falls to the circulating nurse and the scrub nurse to visually and audibly verify that the drug vials match the labels on the cup.
The scrub nurse draws the injectable into the syringe.
Now, this was done, but the syringe was possibly not labeled, and Well, this sounds like a rather protracted process.
I'll tell you what Why don't we reverse things and play it forward? So we go from the circulating nurse to the scrub nurse to the resident, and then to who, doctor? To me.
And does it stop there? With you? Yes, sir.
If only that were true.
You see, when applying the "Captain of the ship" doctrine, it becomes necessary to take a good, long look at the ship.
The ship, as I see it, is Chelsea general.
Who then would be the captain of that ship, Dr.
Delany? I guess, uh I guess you.
Me.
Allison Cabrera's death is on me.
How do you think that makes me feel? You will cancel all and any procedures you have scheduled for today, then you and I will meet with the parents of Allison Cabrera, and together, we will attempt to explain why their daughter is no longer among the living.
After that, all your privileges at Chelsea general will be terminated.
I expect you to clear out your office by the end of the week.
That's all, Dr.
Delany.
27-year-old versus tree impaled by a branch.
How? Plunged off the roof of a three-story in Southeast Portland.
The drop-by hotel.
That's its name, for real.
Ironic place for a jumper.
They should rename the place the fleabag motel for its clientele.
Pressure's hovering at 70 systolic on lactated ringers.
Sinus tach 140s.
O2 sat was 83 on 6 liters with labored breathing, so we intubated him No response to verbal commands.
- How are his pulses? - Diminished.
He's bleeding everywhere.
Okay, let's start massive transfusion protocol.
Let's get him into the O.
R.
Colon and spleen at least.
Yeah, and probably one arterial tear.
Let's go! Have a wonderful day.
Have Wonderful day.
Have a wonderful day.
Sung.
Hey.
Hi.
No.
No? No "hey.
" No "hi.
" Want something.
What want? I don't want anything.
I just, uh Okay, I do.
I'm being deposed by Mitch Tompkins, the attorney who heats his pool by suing us, and I guess I was looking for a little insight into what to expect.
Bad man.
Not honorable.
But smart.
You no match.
He eat you alive.
He will eat you alive.
Thanks for the advice, Sung.
Sleep with another man's wife, ruin marriage shame.
Want advice? Get "sorry" pamphlet Fran Horowitz.
Superior mesenteric artery is torn.
How's the aorta? Fine.
He's lucky.
Of course, he probably wouldn't see it that way Death wish and all.
Colon's trashed.
Where's the bulk of the damage Small or large bowel? Yeah.
Sponge.
Sponge.
Hemathorax small.
But still, he's gonna need a chest tube.
Figured.
Okay, let's keep him on a ventilator and paralyzed overnight, at least.
Make sure he doesn't tear all the repairs.
Talk to you for a second? Dr.
Delany.
He's got fantastic hands, Harding.
I've seen them.
He also finished top of his med-school class at Michigan.
Well, I'll be sure to point that out to Allison Cabrera's parents.
"Your daughter's dead, but take heart.
The doctor who killed her graduated top of his class.
" Not in my character, necessarily, to be compassionate, but what happened to Stewart We all trust our teams The nurses, the anesthesiologists.
This could have happened to any one of us.
Indeed, but it happened to Stewart Delany.
You talk of this, Buck, as if it were some kind of fluke a one-off.
Over 100,000 people die every year from gaffes exactly like this Preventable medical mistakes.
100,000! It's considered the sixth biggest killer in the United States.
One study says there are 40 wrong-site, wrong-side, wrong-patient procedures every week! But to simply fire the guy just like that? Yes, just like that.
And if it had been you, Buck, who made the same mistake, you'd be gone, as well.
You know why? It's in my character.
Why would he hire he's med mal, not divorce.
Well, he probably hired the divorce lawyer to go after you.
For me, he just wanted somebody good at skinning a surgeon's hide.
But I don't how This is a no-fault state.
Which prevents him from suing you for pain and suffering, but evidently not me.
You have a lawyer? Scott Henderson said he'd handle the depo.
He's got experience handling Mitch Tompkins, so I'm sorry.
What can you salvage? Some of the small bowel.
It might be enough so he can eat through his mouth instead of a tube.
Oh, that'll be nice.
If he decides to O.
D.
on his next attempt, he'll have an absorptive service to digest all the pills.
Hey, how we doing? Not dead yet, Bucky boy.
Come back later.
Sponge.
Sponge.
Hey.
Hi.
Sorry.
Well, I screwed up.
Stewart, what happened? Michelle, if you want to feel bad for somebody, don't let it be me, okay? If you want, you should cry for the girl's parents, or It wasn't your fault, Stewart.
Are you responsible? Technically, okay, you were the surgeon of record, but It was not your fault.
No family? Still looking.
Oh, now it's a party.
News is bad, Buck.
Still alive.
That's right.
Let's make it all about Buck.
I'm actually with you on this.
His prognosis sucks.
Even if he survives without peritonitis and sepsis, we send him out eating through a tube, pooping into a bag, addicted to pain meds, and no will to live.
What's the point? "What's the point?" That's really your question, Syd? You want to know what's wrong with healthcare in this country? Take a look.
There is your poster boy.
Come again? He is part of the 10%.
Of what? The sickest 10% of medicare beneficiaries that account for 64% of the spending.
This jumper wants to be dead, and we are gonna spend maybe $1 million of money we don't have trying to keep him alive.
Buck, if I decide to hit you, you'll become one of the 10%.
He's bleeding.
Arterial repair isn't holding.
Let's get him back into the O.
R.
Really? Buck! 32-year-old female.
Head-on collision.
Blood pressure is 70 systolic.
Bradycardia.
Obvious skull deformity.
Pupils? Sluggish.
And she's not following any commands.
Let's get a C.
T.
stat.
Page Dr.
Park right away.
Is she gonna die? It's very serious.
She's got a lot of bleeding in her brain.
Dr.
Park is prepping her for surgery as we speak.
I'll be assisting.
We are going to do everything that we can.
Okay.
His portal vein's clotted.
Great.
This could take a while.
Small bowel's shot.
Whole thing's ischemic.
Liver's gone, too.
Take a look.
Yeah, I know.
I did.
Ah, right on cue, Mr.
transplant.
You're in the game.
Really? Bowel, pancreas, liver.
We're not giving them.
We need them.
For him? You want me to for him?! First of all, let me thank you for agreeing to expedite this process.
Litigation is ugly, ugly business.
The idea that we protract it so with so many onerous procedural exercises Best to make godspeed, because as vile as the process can be in a general sense, it figures to be especially repugnant when it involves infidelity, treachery, deceit.
Can we all agree on that? We're not even on the record yet.
Can I talk to you, mark? I'm terribly sorry, but my client is represented by counsel.
I'd like to speak to my husband, please.
Mark.
What are you doing? What are you looking to prove? You know what, Tina? I'm an optimistic guy.
I plan to meet somebody else someday, get married, maybe have a son.
I dream of all kinds of things.
I even imagine my son growing up and getting married.
And the idea that what happened to me might one day happen I guess what I'm trying to prove is that adultery is a bigger deal than we'd all like to pretend.
And if there's a little less of it in the future because of my efforts here, I'll sleep at night.
How's your sleep these days, Tina? I don't understand how this could have possibly happened.
It shouldn't have.
There's no excuse.
Don't you label drugs, for God's sake? Yes, we do, but they get transferred into containers and syringes.
There are checks and safeguards in place, but they weren't followed through properly here.
Mr.
and Mrs.
Cabrera, your daughter died due to our incompetence.
I will bear the weight of her death for the rest of my life, as will Dr.
Delany.
There's no way to spin this.
Allison was admitted for a relatively minor procedure, and We killed her.
I'm so sorry.
Mr.
Cabrera: This is supposed to be one of the best hospitals in the world, and you killed our daughter.
Yes, we did.
Mm-hmm.
Pupils fixed and dilated.
They were sluggish in the E.
R.
brain-stem herniate.
Fine v-fib.
We need to defibrillate.
Paddles are charged.
All clear.
Clear.
Clear.
Clear.
Sinus rhythm.
She's back.
Heart alive.
Brain dead.
She died? She's brain-dead, yes.
She's still breathing on a ventilator, but there was simply too much damage to her brain.
I'm so sorry.
We try fix.
It's too much bleeding.
Oh, my God.
Do you want to sit down for a second? No, no, no.
Can I say goodbye? Can I can I see her? Of course.
We'll get her ready, then What about her organs? Well, uh, uh, did she have an organ-donor card or No, no.
She's a very religious person.
She's a devout catholic.
We talked about giving life whenever and And however we could, so I think she'd be happy to know that She helped save someone.
At the time you and my client's spouse, Dr.
Ridgeway, became conjugal excuse me.
I should not assume facts not in evidence.
Did you become conjugal with Dr.
Ridgeway? Yes.
Thank you.
That happened when, sir? Um, it started a little over a year ago.
And at the time, you knew she was married? Yes.
Did that matter to you? Did that matter to you, Dr.
Wilson, that Tina Ridgeway was married? Yes.
How did it matter? What is the point of this? I'm sorry.
This is trivial to you? I realize you're an important man.
I don't mean to bother you with something so trivial as another man's marriage.
At the time you became conjugal with Dr.
Ridgeway, what consideration did you give to the emotional harm this illicit affair might cause my client? Any? Look, I'm sorry.
The question was, what consideration, if any, did you give to the emotional harm your adulterous affair would cause my client? I I guess not enough.
I see.
How often have you and Dr.
Ridgeway had sexual relations? More than 10? Are you kidding me? More than 10? Yes.
More than 20? More than 50? I'm so sorry the patient died.
So sorry patient die.
I'm so sorry the patient died.
I am so sorry the patient die.
Hi.
Dr.
Park? Yes? Uh, this is a little awkward, but I am so sorry the patient My wife is a devout catholic, as I said.
I overheard the man that is to get her bowel and liver He tried to commit suicide.
He jumped from a balcony? Suicide is considered a sin in our religion.
I cannot have Renee's organs going to a jumper.
What?! We're on hold.
We may find another donor, but maybe a methodist.
Are you kidding me? Look, Gato, maybe it's for the best.
The chances of this guy pulling through Is he waking up at all? He's been trying Moving his extremities.
We've had him off meds for the last two hours.
He's been doing that for about an hour.
I'm Dr.
Villanueva, one of the surgeons here.
Can you hear me, sir? Good.
Your lungs are fine.
You've had some abdominal damage.
We're going to try and take out the tube later today, okay? It won't affect your voice.
You'll be able to talk once the tube is gone.
How did you fall? File a motion for sanctions and costs, and probably prevail.
I've persuaded him not to on the promise that we'll resume tomorrow.
I still can't believe this is a real cause of action Suing me for it's real.
Plus, since she's a surgeon, he's got expectations of economic benefit.
The case is very real.
I cannot advise you on how to answer the question that occasioned you to leave the room.
If you never thought about the husband, the affair just happened One of those things He'll make you out to be callous, unthinking, inconsiderate.
That comes with a price tag.
If, on the other hand, you did consider mark's emotional pain and had the affair anyway, your offense is deemed reflective with reckless disregard for a person's likely suffering.
It comes with a much bigger price tag.
So the police are in there now? Yeah, we gave them five minutes.
I am very confused.
Hello.
Fran Horowitz from risk management.
Hello.
Yeah, we know who you are, Fran.
Yes, well, good news.
I've just come from the husband of the donor.
And since the donee is no longer a sinner, Mr.
Ford is willing to redirect the organs to Mr.
Harriman.
Yeah, apparently he's a good kid College grad, works some kind of geek job.
Who pushed him? His father.
Believe that? His father? What the hell happened? The kid came out from Tucson to track down his dad.
Evidently his dad bailed out on him and his mother years ago.
Hotel's a flophouse, dad's a tweeker, and he crashes there.
Guess he didn't want to be found.
So he pushes his son off a roof?! All I know is someone saw him fall and assumed he was a jumper.
And the father? That punk's in police custody.
My God.
You know, I must say I do not handle many of these cases.
I I find them to be rather sordid, as a rule.
Of course, I'm a bit of a prude, so that could be me.
Do you find extramarital affairs to be at all sordid, doctor? I try not to draw general rules about anything.
I look at my life, my work on a case-by-case basis.
That was a splendid answer.
It's almost as if you had the night to think about it.
Objection.
Tell me.
How did it happen You and Dr.
Ridgeway? How did you meet? How did we meet? Yes, how did love come to bloom? Well, we work together.
Ah.
You met as fellow neurosurgeons.
Yes.
Makes sense you had a professional relationship as colleagues, and it, um, progressed? Would that be a good word? It progressed? Uh, okay.
And would it be a natural or unnatural progression? Excuse me? Well, forgive me, but doctors work together all the time without their relationships turning sexual.
You would agree that this was an aberrant turn of events.
No, I most certainly would not agree.
We worked 20-hour days.
You and Tina? Doctors, surgeons.
We spend our lives together.
Personal relationships happen.
Oh, please.
Doctors commonly get together socially, sexually? Y-yes.
What? Name three.
Name three other relationships or affairs that have happened between co-workers at Chelsea general.
I'm not gonna name names.
Because you can't.
You can't even name three.
I could name 20.
Oh, 20 now! At least.
And the hospital is okay with this? Any rules in play that govern the sexual We're done.
Excuse me? We're done.
I need to speak to my client.
I'm afraid I am not done, and if you unilaterally walk out of these proceedings again, I will go for sanctions.
I do not care.
We are done.
I should have seen it coming.
He's going after the hospital.
The hospital? Of course.
He plans to show that relationships are both common and foreseeable.
Plus the relationship began while you were both acting under the apparent scope of authority as surgeons.
That's ridiculous.
Yeah, perhaps, but arguably colorable, which means I'm out.
It's a conflict.
I can't represent you since I represent the hospital.
You'll have to get separate counsel.
Seriously? Seriously.
One last piece of advice before I officially withdraw as your lawyer Settle this quickly.
You'll get crushed.
Wait, wait.
"Settle" because I had a social relationship with a colleague? With a married colleague, yes.
Settle.
You're gonna get crushed.
I'd like to give him another day, get him a little stronger, replace more blood.
We can keep the donor patient on the ventilator, maybe give it a go tomorrow.
His mother's en route from Tucson.
It might be best to wait till she gets here anyway.
He has lost a lot of blood already.
We got to get his crit up.
We'll need to give him transfusions overnight if You'll get it.
Let's just step back.
Syd, we've seen the havoc wreaked inside this kid.
It's a miracle that he's made it this far.
Buck, you had a glimpse, too.
Do you actually think we can pull this off? His father pushed him off a roof.
I'm not tossing him under a bus.
I will save this kid.
Hey.
Howdy.
L.
A.
true? It's where I'm from.
I got nothing here, so I mean by nothing, I mean in terms of employment.
I was very much enjoying getting to know you.
Maybe after the horror of this subsides, hooten will somehow No, he won't.
You know why? He's right.
What can I do? Keep in touch.
I promise.
Can you give me a moment? Sure.
Can you save him? So far, we've been able to.
Your son suffered a lot of internal injuries.
His bowel was destroyed.
His liver's failing.
He needs a transplant now.
Oh, my God! He'll be in excellent hands, Ms.
Harriman.
He's clearly a warrior.
Not many would have survived the fall he took.
Please save my boy, doctor.
We'll try everything we can.
Believe me.
Okay, we are taking the liver off ice.
Mark the time to reperfusion.
Goal is under 30.
How we doing? We're on the clock.
Hey.
Hmm? Lousy day, huh? Listen, I know you've got stuff you're dealing with.
Plus, uh, I'm just a monkey.
It's not my place to do battle with the elephants, but Stewart Delany Do you think if a bunch of us went to hooten, we could convince him that Oh, Michelle, you know what Harding Hooten's nickname has been at Chelsea General for years? Hardly human, but frankly, I haven't seen that.
Well, because he's mellowed some, except when it comes to the standard of care.
On that, he is as intractably inhuman as ever.
You'll never move that elephant.
How are his hemodynamics? Looking great at this end.
Fine.
One last look.
No tension or torsion of the vasculature.
Hemostasis good.
And I believe this young man gets to remain among the living.
Let's close.
This is not to say you're not an asshole on occasion, Buck, 'cause you are, but you're one hell of a good surgeon.
I'll second that.
Man can't handle a compliment.
Could be his first.
Suture.
Right here.
Ma'am? Well, well, well.
I don't feel so great.
Well, you're not supposed to.
You just got shoved off the roof of a building.
But you're one tough kid.
I can tell you that.
Thanks For saving me.
Oh, is that what he's telling you? He saved you? Oh, this is Dr.
Napur.
I know.
I was in and out.
I remember you all.
How long before I get to go home? Don't push it, my brother, okay? Just kick back, heal.
Okay, let's get started.
If we finish this quickly, we can all carry on.
Dr.
Wilson and Dr.
Ridgeway, you two like to carry on, am I right? Please stand.
Again, it's not my endeavor to traipse the bedroom through hospital procedures, but what happens in Vegas doesn't always stay in Vegas, does it? Chelsea general is being sued, and it seems Mitch Tompkins has laid out a cause of action alleging our complicity in your adulterous affair A cautionary tale for all, I suppose.
You may sit.
Oh, I feel like a bit of a cow this week, kicking everyone when they're down.
I suppose I should offer some milk.
Dr.
Villanueva, Dr.
Tierney, Dr.
Napur, please ascend, take the stage.
I present to you all our heroes of the day.
Together they saved a young man, who, for all intents and purposes, should be rather dead.
I so love looking at heroes.
I especially enjoy seeing them on display in my hospital.
Was it a grand feeling saving Keith Harriman? It must have been grand.
What did we do wrong? Wrong?! Dr.
Napur, your patient was more pulled apart than the scarecrow in "The Wizard of Oz," and you pulled him back together.
Such excellent doctoring, or should I say fortitude? How did you manage to keep such a positive attitude in the light of this young man's underwhelming odds? Tell me.
Was your attitude positive right from the get go? You seem confused.
As am I, looking at my notes.
Let me see.
You know, my intel around here is pretty good.
Dr.
Napur, you remarked on how lovely it would be if Mr.
Harriman could eat through his mouth instead of a tube.
It would make it easier for him to take his pills on his next suicide attempt.
And, Buck, you pointed to the patient as the poster boy for everything that's wrong with American healthcare.
"A suicidal deadbeat who drains the system.
" Dr.
Napur, I'm told that you concurred with Dr.
Tierney's analysis, which the patient heard, by the way.
I didn't exactly say that.
No.
No, you didn't exactly say that.
What you said was, "even if he survives, "we'll just be sending him out to poop into a bag, addicted to pain meds, with no will to live.
What's the point?" That's what you said Exactly.
And, Dr.
Villanueva, you said Nothing.
In the face of these indecencies, you said nothing to reprimand them.
I believe I threatened to hit Buck.
Twice.
Oh, please.
The truth of the matter is you three heroes didn't really kick into hero gear until you realized that the patient was an attempted-homicide victim.
When he was just a jumper, your concern, if we can even call it that, was far less considerable.
You were all inclined to do just a little bit less for a homeless drug addict than you were for a college graduate.
Buck, you even resisted bothering to waste good organs on the man.
I find that outrageous.
The three of you might consider something Suicidal people are regarded as ill, and if you bother to read the mission statement of this hospital, you'll discover that we rather fancy treating the sick, not shunning them.
Excellent doctoring, indeed Judging the quality of a man's life before deciding on the quality of his care.
Well, perhaps there are death panels in this country, after all.
You're out of line.
You Were out of line, Dr.
Napur.
Your litmus test on best efforts was as out of line here as it was inaccurate.
Uh, I'm sorry.
But whatever they might have said, I You said nothing, Dr.
Villanueva, or at least not enough, and I very well suspect that your attitude was aligned with theirs and they picked up on your cue.
Where the hell did you get that? I get that because I know it, Gato.
Everyone here follows your lead.
They pick up their cue from the big cat.
I'm disappointed.
I'm disappointed in your lack of leadership here.
I'm disappointed in all three of you, heroes that you are.
You okay? I'm not nearly as guilty as you made me out.
But I'm more guilty than I'd like to admit.
I'm sorry.
Now back to my question.
Are you okay? I know you take mistakes at this place personal sometimes.
Go easy on yourself, would you? You worried about me, Gato? If not me, then who? Don't you know that I'll be around to guide you? Really? Drinking alone? Returning nightmares You okay? Ty, this was my You had no duty here.
This is on me.
This was my I disagree.
You took a risk, Tina.
You had something to lose here, which you lost.
Me I just went for a joy ride.
As far as I'm concerned, my behavior was worse than yours here.
I don't know how you get that.
There are consequences to things.
I know I don't need to be telling you that.
But The things we do have meaning.
Crosses Ah.
I think this thing between us Crosses I want it to have meaning.
What are you saying? Maybe it's to ease my guilt.
I-I don't know, but I want what we are I want it to have meaning.
The place my head is at right now I know.
I know.
Looks on their faces ignore them tonight and you'll be all right there's one way out, no way in back to the beginning there's one way back to home again to where I feel forgiven You're a good man And a good doctor.
But my best methodology for preventing these accidents from happening again is zero tolerance, and I must make sure Doctor, I don't disagree with your position.
It's not just the right call.
It's the only one.
It's I wish you well.
Only love You too.
It's only pain it's only fear that runs through my veins it's all the things you can't explain that make us human that make us human that make us human