Code Black (2015) s01e10 Episode Script
Cardiac Support
I'm pretty sure it's like "Game of Thrones" in this place right now.
Everyone's aiming their arrows at the new queen.
Temporary queen.
But here I am, and I have a job to do.
So I've been working my way through Taylor's staff notes.
No small feat because they're written in, you know, Martian Snark, and I see here that you haven't taken a day off in a month, haven't had a vacation in three years.
I appreciate the dedication, but from a liability standpoint, I'm gonna need you to work the regular schedule.
When you've been here longer than five minutes, you'll understand that Angels is not a regular hospital.
- Got to go.
- Go save some lives.
Good talk.
Angels base, we don't have thorazine on the rig.
How far out are you? We're on your 142, say again? Did you say on the ramp? 142, this is Angels base.
Do you copy? 142? What do we have? I don't know.
What's he doing? Looks like he stalled.
Why isn't anyone getting out? Christa, go get security.
What the Hell no.
- Jesse! - Aah! Hey, get back, get back! - Drop it! - Take it easy! All right, get him down.
Get him.
Get that arm.
Ready? Go! - Hey, you all right? - I'm okay.
Pupils reactive.
- Restraints! - Hold still.
How is she? Get a C-collar.
The Hulk looks like he has superficial injuries.
Minor abrasions on his elbows and knees.
Minimally conscious.
Moving spontaneously.
- Positive battle signs.
- Dilated pupils.
He's obviously on something.
I think he's gonna need a hefty dose of ativan.
Breath sounds bilaterally.
Minor abrasions everywhere.
Get on his leg! Keep him down! All right, bite marks on the shoulder and clavicle.
De-gloving of the left knee, probably from the oxygen tank valve.
Let's move her.
Count of three.
1, 2, 3.
That's it.
Great.
Careful.
Okay.
Let's go.
Let's get him inside now.
- Let's bring it in bed one.
- I'm sorry.
I can't hear you.
We have traumas coming in.
Tighten the restraints over there.
You okay, mama? - You went down pretty hard.
- You call that hard? Okay, Jody.
Just try and breathe deeply for me.
You're in Center Stage at Angels.
Risa, methylene blue, please.
Inject it into the capsule through the skin.
My partner, Jeff.
How is he? He's here.
We're working on him.
Do you know what happened? We picked a guy in Pershing Square, passed out.
We were on our way to Angels when we woke and he just went crazy.
Hold on.
I'm sorry.
Almost done, all right? - Hang in there.
- Joint looks intact.
Close it up, please, and push eight of morphine.
- Do we know what he's on? - No.
Never seen anything like it.
You got to stop.
You got to stop it.
Okay, you've give him elephant-dose benzos.
- Yeah, with minimal effect.
- Suggestions, young squire? Knock this zombie out till whatever he took wears off.
Let's get some propofol.
Sir, we're gonna give you a chemically-induced time out.
Amy, prep RSI, please.
Whoa, whoa, whoa.
What is this, Christa? Uh, blood in the airway caused by the trauma.
And how do we proceed? We need to see if the bleeding's coming from the left or right lung.
I'll grab the bronchoscope.
Or we could use our instincts.
- Deformity's on the right side of the chest, correct? - Excuse me.
- More than likely, the bleeding's in the right lung.
- Dr.
Rorish.
- Jesse, airway DL sux and etomidate.
- You're not attempting - a blind intubation, are you? - Jesse, mask, please.
How will you see the bleeding source without a scope? Thank you.
There we go.
Okay, so bleeding is on the right side, - so we need to intubate on the left.
- We should call pulm.
- Leanne, do you hear me? - It's hard not to.
We know how to use a scope, Gina.
If I wait for the gear, he'll die.
Tube, please.
I'm in.
We're running low on nasal packing.
I'll go get some.
You want to take over here? Thank you.
All right, Christa.
We'll need a CT head/neck, please.
Let's go find you.
Ooh, man.
Where is it? Oh! We were trying to help this guy.
And this is what we get Nearly killed.
The CT scan confirms that he has a basilar skull fracture, but, Dr.
Lorenson, tell us why he's lucky.
It doesn't appear to be severe enough to require surgery.
- But you have to keep him for a few days.
- Yes.
The fracture exposed the brain and spinal fluid.
We need to watch him to make sure it doesn't develop into an infection.
Luckily, you'll both be back on the rig before you know it.
- Have you seen Jesse? - Mnh-mnh.
Not since we were in Center Stage.
Okay, Dr.
Savetti has some paperwork for you to fill out so he can discharge you.
I think I'll stick around for a while.
Sleeping Beauty may need me to save his butt again.
Hey, that guy who attacked us What the hell was he on? It was like he was possessed.
Negative.
You want him to put negative tox screen on the report? I ran the test twice.
They were both negative.
Young squire, how many times do we tell you, don't rely on tests? Dr.
Savetti.
Can you help your erstwhile colleague here? He's looking for clues into this young man's drug of choice.
His pupils are dilated so we know it's either sympathomimetic or anticholinergic.
So cocaine, meth, LSD, angel dust Yeah, all covered in the tox panel.
All right.
Wait.
His fingertips are yellow.
- You knew.
- I suspected when I saw him earlier.
Dr.
Leighton, you missed that.
I must have overlooked it when he was trying to kill me.
- What is this? - Looks like spice resin.
Spice resin? Is he a chef? Spice is a street name for synthetic pot.
Dealers spray chemicals on dried plants.
It doesn't show up on a drug test.
- Idiots smoke this stuff? - Yeah, it's a cheap high.
Well, not so cheap.
He's on his way up to ICU.
If and when he awakens, he probably won't remember any of this.
See, out of nasal packing.
Jesse went for it a half-hour ago.
Hello.
I'm Dr.
Rorish.
What do you got? 15-year-old Aubrey shopping with her mom We found her on the dressing room floor.
My heart was suddenly racing.
And that's all I remember.
EKG showed atrial fibrillation, normal rhythm restored with metoprolol.
Any congenital heart issues? Heart? No, no, no.
She's perfectly fine.
She was totally healthy.
She's only 15.
Actually, I've been feeling a little run-down lately.
Sometimes I can't catch my breath.
- For how long? - Last few weeks.
- Babe, why didn't you tell me? - You know how you get.
How do I get? What, concerned? - Controlling.
- I am not controlling.
Okay, look, the ambulance brought us here, but I need her to go to our doctor in Beverly Hills, so can we expedite the discharge paperwork? I'd like to keep her here for a while.
She's my daughter, and I need her to be seen by someone that I know and that I trust.
I'm happy to call her doctor.
I mean, how old are you? What, 26? Excuse me, but I probably just saved her life.
No offense, but we can't be a part of someone's learning curve.
- You're not controlling at all.
- Aubrey, not now.
Okay, okay, okay.
How about we all just take a minute, and then we'll call her doctor together.
I'll explain what happened, and you two can decide together what's best.
Dr.
Pineda.
Oh, crap.
Jesse.
Jesse.
Jesse.
Somebody, help! I need help in here! Come on.
You can't die in my first week, Jesse, please.
Someone! Somebody get help in here! I need help in here! Someone! You've lost your cool like that more than once recently.
I'm sorry.
I'm just tired.
I'm worried about Carla and she won't even speak to me.
Somebody get help! This program is the second-hardest thing you'll ever face.
Carla's illness is the first.
You may have to decide if you can do both.
Somebody, please help me in here now! Excuse me, Dr.
Pineda.
What do you have? 47-year-old male clipped by incoming Metro train, thrown back against station wall.
Blunt trauma to chest, abdomen.
No LOC, minimal EBL.
BP 80 over 50.
Someone has to get Eli! Center Stage, please.
He's going to Bed Three.
I need help in here! Someone! Oh, my God.
Get a gurney in here now! - I need a chest X-ray, please.
- Eli.
On me.
1, 2, 3.
Eli.
- Roll him, please.
- Ow! Gently, gently.
Take it out slowly.
Is Eli your son? - Yes.
- Okay.
I was supposed to pick him up he's at the bus stop at Western and Third, waiting for me.
He has Down Syndrome.
Is there someone we can call? No, he'll get scared if I'm not there.
- He could get lost.
- X-ray ready.
Clear for X-ray.
Clear.
What do you see? Multiple rib fractures, vascular markings all the way to the periphery.
No hemothorax.
Clavicular dislocation, but not compressing the airway.
Good.
He needs ultrasound.
My son's afraid of the dark.
And that's pelvic free fluid.
Talk to me through it, Dr.
Savetti.
Most likely a leak from the bladder.
Could have been blown open by the impact of the train.
- You're gonna need surgery, David.
- Ow.
Wait, please.
There's a Yoda doll in my coat pocket.
It's his.
You'll need it.
- Need it for what? - When you go get him.
It's how he'll know you're safe.
All right, the paramedics can pick him up.
- We'll get him here.
- You promise? Yeah, I promise.
- Clear a path.
- What is it? - Oh, my God.
- We didn't get a call.
- Can you see who it is? - Oh, no.
- I can't believe it.
- Hey, what's going on? - What happened to him? - Is he conscious? - What's going on? - Find Dr.
Rorish.
- I need the cath team activated now.
- Holy Dr.
Rorish, it's Jesse.
Get a crash cart and a defibrillator.
Get an airway ready.
Let me in.
Jesse.
You are not leaving me.
I need someone from Cardiology down here now.
- Oh, my God.
- 12 lead, stat.
- Got it.
- Leanne, are you okay? - I can come and help.
- Yeah, stay with your patient.
Okay, Malaya, talk to him.
Hold his hand.
Angus, ultrasound.
What does it say? Dr.
Leighton! If you can't be useful to me, get out.
Fight, mama.
You hear me? You have to fight! Markedly reduced ventricular function.
EF is 20%, maybe 30%.
I don't see an embolus or a rupture.
Let's get these on.
Okay, massive heart attack.
Diffuse S.
T.
elevations in II, III, and AVF.
Probably the inferior right ventricle.
Christa, vitals? BP borderline 90s over 60s.
Heart rate 80s.
He's sat'ing well.
I activated a code stemi.
Take a look at this EKG, and I want to know the exact time this happened.
Malaya, what's the single-most important thing we can do to save this patient's life? He needs a cath lab.
The heart attack was caused by a blockage in one of his arteries.
- He needs a stent to break it up.
- How long do we have? 90 minutes from door to stent.
Are we in the window? Um, he hasn't Q'ed out yet.
He still has hyper-acute T-waves.
This probably happened less than an hour ago.
He's conscious.
Jesse.
I know you're scared, but I got you, mama.
You hear me? Cardiology's here.
Cath lab's ready for him.
I'm going with you.
Look, I get this is tough.
- I know Jesse's daddy, but - Mama.
Jesse's mama.
Mama.
Maybe I don't quite get it, but I have an ER to run.
I need you to say something motivational, get the people back to work.
I would, but coming from me, it might seem like I'm a cold, unfeeling bitch.
From you, they'll understand.
Okay? Uh, hey, everyone.
Look, I know mama is on all of our minds.
Let's give ourselves a moment to say a prayer for him, and then we have to get back to our patients and give them the same care and attention that we've just given to Jesse.
'Cause you all know mama's number-one rule.
We're not allowed To kill a guest in mama's house.
- Dr.
Guthrie? - Yes.
She is here about a patient that came in just before shift change.
Kyle Eldrich? Yeah, he's my husband.
I'm Debbie.
Stabbing victim.
This young man was taken up to the O.
R.
Yeah, how is he? Please.
His wounds are severe.
He's being prepped for surgery.
Okay, see, he has to be okay.
'Cause he just got back from a tour in Afghanistan.
- Oh, he's active duty? - Yeah.
68 Whiskey.
68 Whiskey? I'll check on him.
Thank you.
Hey, son.
Your patient's wife just got here.
She was asking about him.
Well, he's holding on.
I'll know more when I get inside.
Well, I just wanted you to know that this young man is army, just like you and me.
Matter of fact, same M.
O.
S.
and unit as you.
- Yeah? - Yeah.
- He's a Whiskey? - Yeah.
Boy, those medics saved me more than once when I was still in the service.
Let's repay the favor, huh? Yeah.
Nothing I'd like more But you saw his chart.
Eight penetrating wounds, EBL nearly a liter.
BP still 70s over 40s after six units of O-neg.
That's why I'm glad he has you.
No pressure.
Hey.
You want to scrub up, soldier? You sure? Why not? Aw, man, they They're swamped down there.
But rain check? I'll let you know how he does.
Yeah, yeah.
He's gonna pull through.
He has to.
I can't imagine this place without Jesse.
So we'll keep her here for a few hours, I'll monitor her, and I'll call you if anything changes.
Thank you.
Right now, she's stable.
I just want to make sure she stays that way.
Okay, thank you, and I'm sorry about before.
No, I'm the one who's sorry.
You're supposed to worry about your daughter.
What the hell is this doing here? Isabel, did the paramedics forget to take this with them? They got called out and didn't get a chance to go for the boy.
- I'm waiting on a call back from social services.
- Are you kidding me? That kid could be out there somewhere alone.
He could be in trouble! Yell at me again, I'm gonna put you over my knee.
I'd like to see that.
- What's going on? - Eli's still out there.
No one went to go find him.
I got to go get him.
Hey, hey! We're all on edge.
Someone's got to get that kid.
I promised his father.
Well, you can't go Not now.
We're already down a doctor and a nurse.
I'll be quick.
Dr.
Savetti, you're not going.
Call social services or ask the police to get the boy.
- Okay, what is it? - I need a favor.
I am not taking that impacted bowel from you.
I need you guys to cover for me while I go find my patient's kid.
But Dr.
Hudson said to stay in-house.
We could all get into trouble, I know.
I can't just leave that kid out there.
I'm in.
It's a kid with Down Syndrome alone out on the street.
Okay.
I'm in.
Guys, we could get suspended or worse.
Okay, you better hurry.
I'm not a very good liar.
- One time, at summer camp - Angus.
Thanks, I'll be quick.
Malaya, Aubrey Clark is crumping.
- Oh.
- I'll help.
She can't get enough air and her monitor keeps screaming.
She's in sinus, but sats are only in the 80s on four liters.
- Diffuse crackles throughout.
- Okay.
Okay, would you help her? Please fix this! I'm gonna raise the bed so you can breathe a little easier, okay? I need a BIPAP and an ultrasound.
- Page Respiratory, stat.
- Okay, wait a minute.
What are you doing? Her heart isn't pushing her blood forward effectively.
It's backing up into her lungs, which is affecting her breathing.
We're going to start a device called BIPAP that blows high-pressured air into the lungs.
Okay, start at 10 over 5.
- 40 of Lasix.
- Yep.
Aubrey, this is gonna make you feel better, okay? Ultrasound.
That looks like a poor squeeze.
This is global hypokinesis.
Sats back in the 90s.
Okay, you see, this is why she's got to get out of here because this is getting worse.
Based on this ultrasound, this is early heart failure.
- She's not going anywhere.
- What? Okay, wait a minute.
What is causing this, and what can we do? - Okay.
- Hey, hey, hey.
Absent family history or congenital issues, this condition could be caused by cocaine or methamphetamine.
- Is that possible? - No, no.
No, my daughter's not a druggie.
Let's do a tox screen anyway.
No, we don't need to do a tox screen.
You see, this is why I need real doctor here! Mrs.
Clark, right now, I'm all you've got, so back off and let me do my job.
- Malaya, easy.
- You said you were gonna help.
- Tox screen, please.
- Okay, you got it.
It's a big blockage.
You're lucky to be alive.
Heather, aren't you a surgical resident? Yes, but we have to do an interventional cardiac rotation as part of our residency.
I just started mine.
Well, I'm sure you're quite capable, but I'd prefer an attending.
- Looks like a great doctor to me.
- Score.
I'm flattered and offended at the same time.
Light sedation feels pretty good to you, huh? For sure, for sure.
Want to dance? Jesse, stop talking.
Don't worry, Dr.
Rorish.
I'm very good.
I scared you, huh? Well, you're the one shaking in his boots.
You cried.
And it was an ugly cry, too.
You made a face like this.
Listen.
Before I'm dead, there's something I got to tell you.
Shut up.
You're not dead.
Neither are you.
What are you talking about? You're alive.
I know that.
I don't think you do.
You're alive.
They're not.
Jesse, what are you doing? What I'm telling you is that if I die today, my one wish would be that you live.
Really live.
I'm pretty sure that's their wish, too.
Dr.
Rorish.
What? The artery wall in this area appears very thin.
I'm afraid I may rupture it if I move too quickly.
We don't have time to wait.
I think I can get past it without causing any damage.
All right.
We're through.
Okay, there's the blockage.
Now I just need to move the stent in place.
And inflate it.
You officially have an unblocked artery.
- That's it? - No.
Now you have to listen to me when I say, "take the salad.
Lay off the fries.
" A man's got to live.
Have you, uh Have you seen Dr.
Savetti? - You okay, Dr.
Leighton? - Mm-hmm.
I'm good.
Gina got us this pizza.
Have you tried it? Ooh, it is good.
No, maybe later.
Have you seen Dr.
Savetti? Me? Yeah, you.
I believe he took a patient for a CT scan.
Yeah, I hear they're really backed up.
Mm-hmm.
If I, uh, run into Mario, I'll send him your way.
You're not lying to cover for Mario, are you? Are you asking me as an attending or as a friend? What's the difference? The answer is no.
I don't know where Mario is.
If I find out the residents are lying to cover for Mario, there will be a reprimand, and I won't protect you.
I didn't ask you to.
Eli? I was looking for you at your bus stop.
I see you found your way home.
My dad told me not to talk to strangers.
Well, I'm Dr.
Savetti.
Your dad sent me to come get you.
He gave me this.
Can I tell you a secret? Sure.
I like Yoda, too.
When I was a kid, my dad, he, uh He wasn't a good guy like yours.
He'd go out a lot at night and leave me alone.
Were you scared? Hell, yeah.
But I had a Star Wars videotape and I'd play it and it made me feel safe.
What's a videotape? You're messing with me, huh? All right, come on.
Let me call your dad and see if I can tell him you're all right.
Angels, Trauma One, Risa speaking.
Hey, risa.
It's Mario.
Can you tell me if a patient, David Jacobs, is in recovery? - Seatbelt.
- Sure, hold on.
Mario, he is still in surgery.
You want me to check on him Where are you? And be careful how you answer.
I found David's son.
Get back to the hospital immediately, Dr.
Savetti.
I hear he's okay? He seems to be.
Thanks to you.
Well, I needed to win you over somehow.
I figured if I saved Jesse's life, you might like me.
Good strategy.
Thank you.
Forget about it.
And I'm gonna need you to work a regular schedule.
What? Too soon? Your husband pulled through a very difficult surgery, but he is still in critical condition.
Yeah, but he's gonna make it.
Well, we have to wait and see.
We found extensive internal bleeding due to the damage in his stomach and bowel, but he's a Whiskey.
I'm sure he's tough.
Yeah, he's gonna be fine.
I know it.
Has anyone looked at that arm? Oh, it's fine.
Mrs.
Eldrich, how did you know that your husband was in the hospital? Were you there when it happened? Is that a Virgin Mary there? I went to catholic school.
I used to go to mass every Sunday with my mom.
Debbie.
What happened to your arm? - Did Kyle try to hurt you? - God, no.
No, he'd never.
Do you mind if I take a look? Please.
Kyle's been trying to Get me quit my habit.
He's taking me to meetings and all that.
I waited until he was asleep To go out and score tonight.
He must have been following me because he knew where I was.
And I was I was high by the time he came in, wanting to drag me home.
The people I was with got spooked, and before Before I knew it, some son of a bitch had his knife out and And you just left him there.
Why the hell was he following me? I am his wife.
I'm not I'm not his daughter.
- Did you at least call 911? - Yes, of course.
But I was I was coming down and I needed a fix.
- I wasn't seeing straight.
- You just left him there.
Cole.
Your husband survived terrorists and mortar attacks - but he couldn't survive you.
- Stop.
No, she needs to hear this.
You did this to him.
It should be you in that damn ICU, not him.
Cole, that's enough.
Oh, Jesus.
I'm so sorry.
I'm so sorry.
You know, we have a command hierarchy for a reason.
We allow the residents to ignore it and there are consequences for the patients.
I knew you had a tough job, but I didn't know how hard.
I'm confused.
About what? You're the one who said that every resident is a lock and you just have to find the right combination.
I still believe that.
Mario just did two things he could have never done before.
He put himself at risk for a patient and he reached out for help.
He disobeyed you, yes.
But he also proved your point That they're all teachable.
- So you wouldn't discipline him? - Me? I'd throw him out of the program if I knew he did this.
But I don't know a thing about it.
I got to go check on Jesse.
So I'm sorry, I just I just came to check on him.
Maybe I'll just come back.
I heard you had to take Eldrich back into surgery.
He's dead.
Oh, man.
Three liters of blood in the belly.
The liver's shredded to pieces.
I tried, but I couldn't save him.
Yeah, I'm sure you did the best you could.
- I'll go talk to his wife.
- No, he was my patient.
I don't think that's a good idea, son.
You already said enough.
You don't get to make that decision.
Wait a minute, Cole! It's my responsibility.
- Yeah.
- Excuse me.
Have you seen Kyle Eldrich's wife? - Ugh, I'm so sorry.
- What is it? She overhead some of the trauma nurses talking.
She knows her husband didn't make it.
Well, where is she? She said she was gonna go clean up in the ladies' room.
Debbie? Debbie.
I don't want this.
I don't want this.
I don't want this.
Help me.
- It's okay.
It's okay.
- Help me.
It's okay.
We were able to wean your daughter off BIPAP with Lasix.
- Mm-hmm.
- That is the good news.
Her tox panel came back.
There's no meth or cocaine in her system.
Yeah, I told you.
But her thyroid levels are so high they can't be measured by our laboratory.
She's in a thyroid storm.
What What is a thyroid storm? A side effect of thyroid meds is weight loss.
Sometimes patients abuse those meds to get thin, but the excessive hormones in the blood can reach toxic levels.
It's called a thyroid storm.
It can cause heart failure and abnormal rhythms.
Aubrey, we've noticed from your medical records that you've lost quite a few pounds over the last year.
From diet and exercise.
You don't have a prescription for thyroid medication, but we've known some girls to sneak their mom's pills.
Do you have a prescription, Mrs.
Clark? Yes, I do.
I've never taken my mom's pills.
The only thing I take are my vitamins.
Mom, you believe me, right? Yes, honey, of course I do.
Mrs.
Clark, could you step out with me, please? You did this, didn't you? What are you talking about? She could die, and you're still lying.
Who the hell do you think you are, young lady? My name is Dr.
Pineda.
Are you gonna tell the truth or not? What's going on here? She's gmng her daughter her thyroid medication without her knowledge.
Am I right? Answer me! Am I right? Are you gonna let her talk to me like this? You bet your ass I am.
She could die if you don't tell me the truth.
Did you give her your medication yes or no? Yes.
Yes, but I didn't think that this was gonna hurt her.
You wanted her to lose weight so you gave her your medication and you told her it was a vitamin.
Mom! Is that true? Honey, I never ever meant to hurt you.
I just wanted I wanted you to like yourself, honey.
And it worked! Didn't it? It worked.
I wish there was a drug to make you like me, mom.
- Aubrey.
Aubrey, honey! - She's in V-tac.
Angus, let's get her back in bed.
Honey! - He's bleeding out again.
- He's been fine until now.
I thought Dr.
Rorish fixed the bleed with the breathing tube.
Me, too.
I need thoracic, or I.
R.
or Oh, he's starting to vomit.
The tube could come out.
Do something! Oh, my God.
- Should I page Dr.
Rorish? - No! Hudson, we need a surgeon.
- How's my heart rate? - 210.
It's fast, but it's not irregularly irregular.
I don't think it's A-fib.
It's worse.
It's a paroxysmal SVT.
Get me to Center Stage.
I need Leanne.
Aubrey! Malaya, pads.
- Charging.
Ready? - Okay, clear.
And now.
She's in sinus rhythm.
- Is she gonna be okay? - She's gonna be okay.
She's gonna need anti-thyroid medication.
Isabel, call the pharmacy.
- Mom? - Oh, honey, I'm so sorry.
I I'm so sorry.
Doctor.
- Coming through.
- What happened? I missed you.
Heather, what is it? Paroxysmal supraventricular tachycardia.
Uh, Mario, get over here.
Heart rate in the 200s.
- What's his BP? - High 100s over 60s.
Okay, post M.
I.
, this kind of heart rate places excessive demand on already stressed cardiac tissue.
How do we proceed from here? Are you still really teaching now? I mean, this is me on the table.
Mario? - Adenosine.
- That's right a medication That will literally stop your heart.
- Why? - Because it Heather.
Why would we want to stop his heart? To restart it like a computer.
Exactly.
It should restore normal heart rhythm.
What's the catch? I'll tell you what the catch is.
You're gonna do it while I'm still awake, and it's gonna hurt like hell.
I'm sorry, mama.
Get it done already.
He was fine all shift after we intubated him.
I've checked the BP twice.
It's still low.
Okay, this breathing tube has to come out.
I need to take a look at the bronchi to see the bleeding.
What, extubate him? He could bleed out.
No, patients with bleeding lungs don't die from losing blood.
They drown in it.
Hey.
Jesse, I'm gonna tell you something.
I must be about to die because you're gonna say something touchy-feely.
You're not gonna die because I need you.
Okay? I need you.
I know.
I love you, too.
Risa, grab another airway.
Dr.
Lorenson, tube out, now.
Be ready to re-intubate.
Okay, I think I see the bleed.
It's in the left mainstem.
Oh, my God.
We intubated the wrong mainstem earlier.
Nobody used the bronchoscope the first time? Dr.
Rorish intubated blind.
Okay.
Thread the new breathing tube over my scope.
Sat's in the 80s.
You ready? I'm ready.
Okay, stand by.
Okay.
Sat 75%.
And I am in.
Dr.
Lorenson, inflate the tube, please.
Good breath sounds on the right, not on the left Just what we want.
Let get some fluids in him, please, and up to the I.
R.
Sat's normalizing.
Dr.
Rorish, we're ready.
Okay.
Jesse, you ready? Save my life, daddy.
All right.
- Sinus rhythm.
- Blood pressure's back.
He's good! He's good.
Oh, my God.
Oh.
Okay, mama.
You're not going anywhere, okay? You're not going anywhere.
Oh, I love you.
Did you find an open bed in the addiction clinic for Mrs.
Eldrich? The way you talked to that woman, Cole, in her state, your temper almost killed her.
- I told her what she needed to hear.
- No.
You told her what you needed her to hear.
We both know what that temper has cost you in the past, son.
I hoped that you when you came here, you'd have put all of that behind you.
I don't need a father-and-son talk from you.
This isn't a father-and-son talk.
This is a senior faculty member telling a new attending that his behavior is unacceptable.
He'll wake up soon.
I'm here, dad.
My friend Mario told me you're gonna be okay.
Eli? Dad.
Don't worry, dad.
I'm gonna take care of you.
Do you have an explanation for what you did today? Not really.
Not really.
That's it? That's an appropriate answer? I was trying to be Mayonnaise.
Mayonnaise? Something Jesse said from that movie, "Officer and a Gentleman.
" They called him Mayonnaise 'cause he's white and his name's Mayo.
I've seen the movie.
I'm talking about I was just trying to do the right thing, man.
For Jesse.
All right.
What about the others? Do they get a pass? This time.
Thank you.
Thank you.
There were, uh, complications with your patient, Jeff, the paramedic.
He's fine, but the bleed was on the left side, not on the right.
I intubated the wrong side? I could have killed him.
Well, you didn't.
I corrected it, so Don't do that, Leanne.
Don't internalize this.
We all make mistakes.
Not like that one.
What is it Jesse says? "Lean on each other.
That's what siblings are for.
" You think he's all you have, but you're wrong, Leanne.
You have me.
You have all of us.
Thank you.
What are you doing? Living.
Everyone's aiming their arrows at the new queen.
Temporary queen.
But here I am, and I have a job to do.
So I've been working my way through Taylor's staff notes.
No small feat because they're written in, you know, Martian Snark, and I see here that you haven't taken a day off in a month, haven't had a vacation in three years.
I appreciate the dedication, but from a liability standpoint, I'm gonna need you to work the regular schedule.
When you've been here longer than five minutes, you'll understand that Angels is not a regular hospital.
- Got to go.
- Go save some lives.
Good talk.
Angels base, we don't have thorazine on the rig.
How far out are you? We're on your 142, say again? Did you say on the ramp? 142, this is Angels base.
Do you copy? 142? What do we have? I don't know.
What's he doing? Looks like he stalled.
Why isn't anyone getting out? Christa, go get security.
What the Hell no.
- Jesse! - Aah! Hey, get back, get back! - Drop it! - Take it easy! All right, get him down.
Get him.
Get that arm.
Ready? Go! - Hey, you all right? - I'm okay.
Pupils reactive.
- Restraints! - Hold still.
How is she? Get a C-collar.
The Hulk looks like he has superficial injuries.
Minor abrasions on his elbows and knees.
Minimally conscious.
Moving spontaneously.
- Positive battle signs.
- Dilated pupils.
He's obviously on something.
I think he's gonna need a hefty dose of ativan.
Breath sounds bilaterally.
Minor abrasions everywhere.
Get on his leg! Keep him down! All right, bite marks on the shoulder and clavicle.
De-gloving of the left knee, probably from the oxygen tank valve.
Let's move her.
Count of three.
1, 2, 3.
That's it.
Great.
Careful.
Okay.
Let's go.
Let's get him inside now.
- Let's bring it in bed one.
- I'm sorry.
I can't hear you.
We have traumas coming in.
Tighten the restraints over there.
You okay, mama? - You went down pretty hard.
- You call that hard? Okay, Jody.
Just try and breathe deeply for me.
You're in Center Stage at Angels.
Risa, methylene blue, please.
Inject it into the capsule through the skin.
My partner, Jeff.
How is he? He's here.
We're working on him.
Do you know what happened? We picked a guy in Pershing Square, passed out.
We were on our way to Angels when we woke and he just went crazy.
Hold on.
I'm sorry.
Almost done, all right? - Hang in there.
- Joint looks intact.
Close it up, please, and push eight of morphine.
- Do we know what he's on? - No.
Never seen anything like it.
You got to stop.
You got to stop it.
Okay, you've give him elephant-dose benzos.
- Yeah, with minimal effect.
- Suggestions, young squire? Knock this zombie out till whatever he took wears off.
Let's get some propofol.
Sir, we're gonna give you a chemically-induced time out.
Amy, prep RSI, please.
Whoa, whoa, whoa.
What is this, Christa? Uh, blood in the airway caused by the trauma.
And how do we proceed? We need to see if the bleeding's coming from the left or right lung.
I'll grab the bronchoscope.
Or we could use our instincts.
- Deformity's on the right side of the chest, correct? - Excuse me.
- More than likely, the bleeding's in the right lung.
- Dr.
Rorish.
- Jesse, airway DL sux and etomidate.
- You're not attempting - a blind intubation, are you? - Jesse, mask, please.
How will you see the bleeding source without a scope? Thank you.
There we go.
Okay, so bleeding is on the right side, - so we need to intubate on the left.
- We should call pulm.
- Leanne, do you hear me? - It's hard not to.
We know how to use a scope, Gina.
If I wait for the gear, he'll die.
Tube, please.
I'm in.
We're running low on nasal packing.
I'll go get some.
You want to take over here? Thank you.
All right, Christa.
We'll need a CT head/neck, please.
Let's go find you.
Ooh, man.
Where is it? Oh! We were trying to help this guy.
And this is what we get Nearly killed.
The CT scan confirms that he has a basilar skull fracture, but, Dr.
Lorenson, tell us why he's lucky.
It doesn't appear to be severe enough to require surgery.
- But you have to keep him for a few days.
- Yes.
The fracture exposed the brain and spinal fluid.
We need to watch him to make sure it doesn't develop into an infection.
Luckily, you'll both be back on the rig before you know it.
- Have you seen Jesse? - Mnh-mnh.
Not since we were in Center Stage.
Okay, Dr.
Savetti has some paperwork for you to fill out so he can discharge you.
I think I'll stick around for a while.
Sleeping Beauty may need me to save his butt again.
Hey, that guy who attacked us What the hell was he on? It was like he was possessed.
Negative.
You want him to put negative tox screen on the report? I ran the test twice.
They were both negative.
Young squire, how many times do we tell you, don't rely on tests? Dr.
Savetti.
Can you help your erstwhile colleague here? He's looking for clues into this young man's drug of choice.
His pupils are dilated so we know it's either sympathomimetic or anticholinergic.
So cocaine, meth, LSD, angel dust Yeah, all covered in the tox panel.
All right.
Wait.
His fingertips are yellow.
- You knew.
- I suspected when I saw him earlier.
Dr.
Leighton, you missed that.
I must have overlooked it when he was trying to kill me.
- What is this? - Looks like spice resin.
Spice resin? Is he a chef? Spice is a street name for synthetic pot.
Dealers spray chemicals on dried plants.
It doesn't show up on a drug test.
- Idiots smoke this stuff? - Yeah, it's a cheap high.
Well, not so cheap.
He's on his way up to ICU.
If and when he awakens, he probably won't remember any of this.
See, out of nasal packing.
Jesse went for it a half-hour ago.
Hello.
I'm Dr.
Rorish.
What do you got? 15-year-old Aubrey shopping with her mom We found her on the dressing room floor.
My heart was suddenly racing.
And that's all I remember.
EKG showed atrial fibrillation, normal rhythm restored with metoprolol.
Any congenital heart issues? Heart? No, no, no.
She's perfectly fine.
She was totally healthy.
She's only 15.
Actually, I've been feeling a little run-down lately.
Sometimes I can't catch my breath.
- For how long? - Last few weeks.
- Babe, why didn't you tell me? - You know how you get.
How do I get? What, concerned? - Controlling.
- I am not controlling.
Okay, look, the ambulance brought us here, but I need her to go to our doctor in Beverly Hills, so can we expedite the discharge paperwork? I'd like to keep her here for a while.
She's my daughter, and I need her to be seen by someone that I know and that I trust.
I'm happy to call her doctor.
I mean, how old are you? What, 26? Excuse me, but I probably just saved her life.
No offense, but we can't be a part of someone's learning curve.
- You're not controlling at all.
- Aubrey, not now.
Okay, okay, okay.
How about we all just take a minute, and then we'll call her doctor together.
I'll explain what happened, and you two can decide together what's best.
Dr.
Pineda.
Oh, crap.
Jesse.
Jesse.
Jesse.
Somebody, help! I need help in here! Come on.
You can't die in my first week, Jesse, please.
Someone! Somebody get help in here! I need help in here! Someone! You've lost your cool like that more than once recently.
I'm sorry.
I'm just tired.
I'm worried about Carla and she won't even speak to me.
Somebody get help! This program is the second-hardest thing you'll ever face.
Carla's illness is the first.
You may have to decide if you can do both.
Somebody, please help me in here now! Excuse me, Dr.
Pineda.
What do you have? 47-year-old male clipped by incoming Metro train, thrown back against station wall.
Blunt trauma to chest, abdomen.
No LOC, minimal EBL.
BP 80 over 50.
Someone has to get Eli! Center Stage, please.
He's going to Bed Three.
I need help in here! Someone! Oh, my God.
Get a gurney in here now! - I need a chest X-ray, please.
- Eli.
On me.
1, 2, 3.
Eli.
- Roll him, please.
- Ow! Gently, gently.
Take it out slowly.
Is Eli your son? - Yes.
- Okay.
I was supposed to pick him up he's at the bus stop at Western and Third, waiting for me.
He has Down Syndrome.
Is there someone we can call? No, he'll get scared if I'm not there.
- He could get lost.
- X-ray ready.
Clear for X-ray.
Clear.
What do you see? Multiple rib fractures, vascular markings all the way to the periphery.
No hemothorax.
Clavicular dislocation, but not compressing the airway.
Good.
He needs ultrasound.
My son's afraid of the dark.
And that's pelvic free fluid.
Talk to me through it, Dr.
Savetti.
Most likely a leak from the bladder.
Could have been blown open by the impact of the train.
- You're gonna need surgery, David.
- Ow.
Wait, please.
There's a Yoda doll in my coat pocket.
It's his.
You'll need it.
- Need it for what? - When you go get him.
It's how he'll know you're safe.
All right, the paramedics can pick him up.
- We'll get him here.
- You promise? Yeah, I promise.
- Clear a path.
- What is it? - Oh, my God.
- We didn't get a call.
- Can you see who it is? - Oh, no.
- I can't believe it.
- Hey, what's going on? - What happened to him? - Is he conscious? - What's going on? - Find Dr.
Rorish.
- I need the cath team activated now.
- Holy Dr.
Rorish, it's Jesse.
Get a crash cart and a defibrillator.
Get an airway ready.
Let me in.
Jesse.
You are not leaving me.
I need someone from Cardiology down here now.
- Oh, my God.
- 12 lead, stat.
- Got it.
- Leanne, are you okay? - I can come and help.
- Yeah, stay with your patient.
Okay, Malaya, talk to him.
Hold his hand.
Angus, ultrasound.
What does it say? Dr.
Leighton! If you can't be useful to me, get out.
Fight, mama.
You hear me? You have to fight! Markedly reduced ventricular function.
EF is 20%, maybe 30%.
I don't see an embolus or a rupture.
Let's get these on.
Okay, massive heart attack.
Diffuse S.
T.
elevations in II, III, and AVF.
Probably the inferior right ventricle.
Christa, vitals? BP borderline 90s over 60s.
Heart rate 80s.
He's sat'ing well.
I activated a code stemi.
Take a look at this EKG, and I want to know the exact time this happened.
Malaya, what's the single-most important thing we can do to save this patient's life? He needs a cath lab.
The heart attack was caused by a blockage in one of his arteries.
- He needs a stent to break it up.
- How long do we have? 90 minutes from door to stent.
Are we in the window? Um, he hasn't Q'ed out yet.
He still has hyper-acute T-waves.
This probably happened less than an hour ago.
He's conscious.
Jesse.
I know you're scared, but I got you, mama.
You hear me? Cardiology's here.
Cath lab's ready for him.
I'm going with you.
Look, I get this is tough.
- I know Jesse's daddy, but - Mama.
Jesse's mama.
Mama.
Maybe I don't quite get it, but I have an ER to run.
I need you to say something motivational, get the people back to work.
I would, but coming from me, it might seem like I'm a cold, unfeeling bitch.
From you, they'll understand.
Okay? Uh, hey, everyone.
Look, I know mama is on all of our minds.
Let's give ourselves a moment to say a prayer for him, and then we have to get back to our patients and give them the same care and attention that we've just given to Jesse.
'Cause you all know mama's number-one rule.
We're not allowed To kill a guest in mama's house.
- Dr.
Guthrie? - Yes.
She is here about a patient that came in just before shift change.
Kyle Eldrich? Yeah, he's my husband.
I'm Debbie.
Stabbing victim.
This young man was taken up to the O.
R.
Yeah, how is he? Please.
His wounds are severe.
He's being prepped for surgery.
Okay, see, he has to be okay.
'Cause he just got back from a tour in Afghanistan.
- Oh, he's active duty? - Yeah.
68 Whiskey.
68 Whiskey? I'll check on him.
Thank you.
Hey, son.
Your patient's wife just got here.
She was asking about him.
Well, he's holding on.
I'll know more when I get inside.
Well, I just wanted you to know that this young man is army, just like you and me.
Matter of fact, same M.
O.
S.
and unit as you.
- Yeah? - Yeah.
- He's a Whiskey? - Yeah.
Boy, those medics saved me more than once when I was still in the service.
Let's repay the favor, huh? Yeah.
Nothing I'd like more But you saw his chart.
Eight penetrating wounds, EBL nearly a liter.
BP still 70s over 40s after six units of O-neg.
That's why I'm glad he has you.
No pressure.
Hey.
You want to scrub up, soldier? You sure? Why not? Aw, man, they They're swamped down there.
But rain check? I'll let you know how he does.
Yeah, yeah.
He's gonna pull through.
He has to.
I can't imagine this place without Jesse.
So we'll keep her here for a few hours, I'll monitor her, and I'll call you if anything changes.
Thank you.
Right now, she's stable.
I just want to make sure she stays that way.
Okay, thank you, and I'm sorry about before.
No, I'm the one who's sorry.
You're supposed to worry about your daughter.
What the hell is this doing here? Isabel, did the paramedics forget to take this with them? They got called out and didn't get a chance to go for the boy.
- I'm waiting on a call back from social services.
- Are you kidding me? That kid could be out there somewhere alone.
He could be in trouble! Yell at me again, I'm gonna put you over my knee.
I'd like to see that.
- What's going on? - Eli's still out there.
No one went to go find him.
I got to go get him.
Hey, hey! We're all on edge.
Someone's got to get that kid.
I promised his father.
Well, you can't go Not now.
We're already down a doctor and a nurse.
I'll be quick.
Dr.
Savetti, you're not going.
Call social services or ask the police to get the boy.
- Okay, what is it? - I need a favor.
I am not taking that impacted bowel from you.
I need you guys to cover for me while I go find my patient's kid.
But Dr.
Hudson said to stay in-house.
We could all get into trouble, I know.
I can't just leave that kid out there.
I'm in.
It's a kid with Down Syndrome alone out on the street.
Okay.
I'm in.
Guys, we could get suspended or worse.
Okay, you better hurry.
I'm not a very good liar.
- One time, at summer camp - Angus.
Thanks, I'll be quick.
Malaya, Aubrey Clark is crumping.
- Oh.
- I'll help.
She can't get enough air and her monitor keeps screaming.
She's in sinus, but sats are only in the 80s on four liters.
- Diffuse crackles throughout.
- Okay.
Okay, would you help her? Please fix this! I'm gonna raise the bed so you can breathe a little easier, okay? I need a BIPAP and an ultrasound.
- Page Respiratory, stat.
- Okay, wait a minute.
What are you doing? Her heart isn't pushing her blood forward effectively.
It's backing up into her lungs, which is affecting her breathing.
We're going to start a device called BIPAP that blows high-pressured air into the lungs.
Okay, start at 10 over 5.
- 40 of Lasix.
- Yep.
Aubrey, this is gonna make you feel better, okay? Ultrasound.
That looks like a poor squeeze.
This is global hypokinesis.
Sats back in the 90s.
Okay, you see, this is why she's got to get out of here because this is getting worse.
Based on this ultrasound, this is early heart failure.
- She's not going anywhere.
- What? Okay, wait a minute.
What is causing this, and what can we do? - Okay.
- Hey, hey, hey.
Absent family history or congenital issues, this condition could be caused by cocaine or methamphetamine.
- Is that possible? - No, no.
No, my daughter's not a druggie.
Let's do a tox screen anyway.
No, we don't need to do a tox screen.
You see, this is why I need real doctor here! Mrs.
Clark, right now, I'm all you've got, so back off and let me do my job.
- Malaya, easy.
- You said you were gonna help.
- Tox screen, please.
- Okay, you got it.
It's a big blockage.
You're lucky to be alive.
Heather, aren't you a surgical resident? Yes, but we have to do an interventional cardiac rotation as part of our residency.
I just started mine.
Well, I'm sure you're quite capable, but I'd prefer an attending.
- Looks like a great doctor to me.
- Score.
I'm flattered and offended at the same time.
Light sedation feels pretty good to you, huh? For sure, for sure.
Want to dance? Jesse, stop talking.
Don't worry, Dr.
Rorish.
I'm very good.
I scared you, huh? Well, you're the one shaking in his boots.
You cried.
And it was an ugly cry, too.
You made a face like this.
Listen.
Before I'm dead, there's something I got to tell you.
Shut up.
You're not dead.
Neither are you.
What are you talking about? You're alive.
I know that.
I don't think you do.
You're alive.
They're not.
Jesse, what are you doing? What I'm telling you is that if I die today, my one wish would be that you live.
Really live.
I'm pretty sure that's their wish, too.
Dr.
Rorish.
What? The artery wall in this area appears very thin.
I'm afraid I may rupture it if I move too quickly.
We don't have time to wait.
I think I can get past it without causing any damage.
All right.
We're through.
Okay, there's the blockage.
Now I just need to move the stent in place.
And inflate it.
You officially have an unblocked artery.
- That's it? - No.
Now you have to listen to me when I say, "take the salad.
Lay off the fries.
" A man's got to live.
Have you, uh Have you seen Dr.
Savetti? - You okay, Dr.
Leighton? - Mm-hmm.
I'm good.
Gina got us this pizza.
Have you tried it? Ooh, it is good.
No, maybe later.
Have you seen Dr.
Savetti? Me? Yeah, you.
I believe he took a patient for a CT scan.
Yeah, I hear they're really backed up.
Mm-hmm.
If I, uh, run into Mario, I'll send him your way.
You're not lying to cover for Mario, are you? Are you asking me as an attending or as a friend? What's the difference? The answer is no.
I don't know where Mario is.
If I find out the residents are lying to cover for Mario, there will be a reprimand, and I won't protect you.
I didn't ask you to.
Eli? I was looking for you at your bus stop.
I see you found your way home.
My dad told me not to talk to strangers.
Well, I'm Dr.
Savetti.
Your dad sent me to come get you.
He gave me this.
Can I tell you a secret? Sure.
I like Yoda, too.
When I was a kid, my dad, he, uh He wasn't a good guy like yours.
He'd go out a lot at night and leave me alone.
Were you scared? Hell, yeah.
But I had a Star Wars videotape and I'd play it and it made me feel safe.
What's a videotape? You're messing with me, huh? All right, come on.
Let me call your dad and see if I can tell him you're all right.
Angels, Trauma One, Risa speaking.
Hey, risa.
It's Mario.
Can you tell me if a patient, David Jacobs, is in recovery? - Seatbelt.
- Sure, hold on.
Mario, he is still in surgery.
You want me to check on him Where are you? And be careful how you answer.
I found David's son.
Get back to the hospital immediately, Dr.
Savetti.
I hear he's okay? He seems to be.
Thanks to you.
Well, I needed to win you over somehow.
I figured if I saved Jesse's life, you might like me.
Good strategy.
Thank you.
Forget about it.
And I'm gonna need you to work a regular schedule.
What? Too soon? Your husband pulled through a very difficult surgery, but he is still in critical condition.
Yeah, but he's gonna make it.
Well, we have to wait and see.
We found extensive internal bleeding due to the damage in his stomach and bowel, but he's a Whiskey.
I'm sure he's tough.
Yeah, he's gonna be fine.
I know it.
Has anyone looked at that arm? Oh, it's fine.
Mrs.
Eldrich, how did you know that your husband was in the hospital? Were you there when it happened? Is that a Virgin Mary there? I went to catholic school.
I used to go to mass every Sunday with my mom.
Debbie.
What happened to your arm? - Did Kyle try to hurt you? - God, no.
No, he'd never.
Do you mind if I take a look? Please.
Kyle's been trying to Get me quit my habit.
He's taking me to meetings and all that.
I waited until he was asleep To go out and score tonight.
He must have been following me because he knew where I was.
And I was I was high by the time he came in, wanting to drag me home.
The people I was with got spooked, and before Before I knew it, some son of a bitch had his knife out and And you just left him there.
Why the hell was he following me? I am his wife.
I'm not I'm not his daughter.
- Did you at least call 911? - Yes, of course.
But I was I was coming down and I needed a fix.
- I wasn't seeing straight.
- You just left him there.
Cole.
Your husband survived terrorists and mortar attacks - but he couldn't survive you.
- Stop.
No, she needs to hear this.
You did this to him.
It should be you in that damn ICU, not him.
Cole, that's enough.
Oh, Jesus.
I'm so sorry.
I'm so sorry.
You know, we have a command hierarchy for a reason.
We allow the residents to ignore it and there are consequences for the patients.
I knew you had a tough job, but I didn't know how hard.
I'm confused.
About what? You're the one who said that every resident is a lock and you just have to find the right combination.
I still believe that.
Mario just did two things he could have never done before.
He put himself at risk for a patient and he reached out for help.
He disobeyed you, yes.
But he also proved your point That they're all teachable.
- So you wouldn't discipline him? - Me? I'd throw him out of the program if I knew he did this.
But I don't know a thing about it.
I got to go check on Jesse.
So I'm sorry, I just I just came to check on him.
Maybe I'll just come back.
I heard you had to take Eldrich back into surgery.
He's dead.
Oh, man.
Three liters of blood in the belly.
The liver's shredded to pieces.
I tried, but I couldn't save him.
Yeah, I'm sure you did the best you could.
- I'll go talk to his wife.
- No, he was my patient.
I don't think that's a good idea, son.
You already said enough.
You don't get to make that decision.
Wait a minute, Cole! It's my responsibility.
- Yeah.
- Excuse me.
Have you seen Kyle Eldrich's wife? - Ugh, I'm so sorry.
- What is it? She overhead some of the trauma nurses talking.
She knows her husband didn't make it.
Well, where is she? She said she was gonna go clean up in the ladies' room.
Debbie? Debbie.
I don't want this.
I don't want this.
I don't want this.
Help me.
- It's okay.
It's okay.
- Help me.
It's okay.
We were able to wean your daughter off BIPAP with Lasix.
- Mm-hmm.
- That is the good news.
Her tox panel came back.
There's no meth or cocaine in her system.
Yeah, I told you.
But her thyroid levels are so high they can't be measured by our laboratory.
She's in a thyroid storm.
What What is a thyroid storm? A side effect of thyroid meds is weight loss.
Sometimes patients abuse those meds to get thin, but the excessive hormones in the blood can reach toxic levels.
It's called a thyroid storm.
It can cause heart failure and abnormal rhythms.
Aubrey, we've noticed from your medical records that you've lost quite a few pounds over the last year.
From diet and exercise.
You don't have a prescription for thyroid medication, but we've known some girls to sneak their mom's pills.
Do you have a prescription, Mrs.
Clark? Yes, I do.
I've never taken my mom's pills.
The only thing I take are my vitamins.
Mom, you believe me, right? Yes, honey, of course I do.
Mrs.
Clark, could you step out with me, please? You did this, didn't you? What are you talking about? She could die, and you're still lying.
Who the hell do you think you are, young lady? My name is Dr.
Pineda.
Are you gonna tell the truth or not? What's going on here? She's gmng her daughter her thyroid medication without her knowledge.
Am I right? Answer me! Am I right? Are you gonna let her talk to me like this? You bet your ass I am.
She could die if you don't tell me the truth.
Did you give her your medication yes or no? Yes.
Yes, but I didn't think that this was gonna hurt her.
You wanted her to lose weight so you gave her your medication and you told her it was a vitamin.
Mom! Is that true? Honey, I never ever meant to hurt you.
I just wanted I wanted you to like yourself, honey.
And it worked! Didn't it? It worked.
I wish there was a drug to make you like me, mom.
- Aubrey.
Aubrey, honey! - She's in V-tac.
Angus, let's get her back in bed.
Honey! - He's bleeding out again.
- He's been fine until now.
I thought Dr.
Rorish fixed the bleed with the breathing tube.
Me, too.
I need thoracic, or I.
R.
or Oh, he's starting to vomit.
The tube could come out.
Do something! Oh, my God.
- Should I page Dr.
Rorish? - No! Hudson, we need a surgeon.
- How's my heart rate? - 210.
It's fast, but it's not irregularly irregular.
I don't think it's A-fib.
It's worse.
It's a paroxysmal SVT.
Get me to Center Stage.
I need Leanne.
Aubrey! Malaya, pads.
- Charging.
Ready? - Okay, clear.
And now.
She's in sinus rhythm.
- Is she gonna be okay? - She's gonna be okay.
She's gonna need anti-thyroid medication.
Isabel, call the pharmacy.
- Mom? - Oh, honey, I'm so sorry.
I I'm so sorry.
Doctor.
- Coming through.
- What happened? I missed you.
Heather, what is it? Paroxysmal supraventricular tachycardia.
Uh, Mario, get over here.
Heart rate in the 200s.
- What's his BP? - High 100s over 60s.
Okay, post M.
I.
, this kind of heart rate places excessive demand on already stressed cardiac tissue.
How do we proceed from here? Are you still really teaching now? I mean, this is me on the table.
Mario? - Adenosine.
- That's right a medication That will literally stop your heart.
- Why? - Because it Heather.
Why would we want to stop his heart? To restart it like a computer.
Exactly.
It should restore normal heart rhythm.
What's the catch? I'll tell you what the catch is.
You're gonna do it while I'm still awake, and it's gonna hurt like hell.
I'm sorry, mama.
Get it done already.
He was fine all shift after we intubated him.
I've checked the BP twice.
It's still low.
Okay, this breathing tube has to come out.
I need to take a look at the bronchi to see the bleeding.
What, extubate him? He could bleed out.
No, patients with bleeding lungs don't die from losing blood.
They drown in it.
Hey.
Jesse, I'm gonna tell you something.
I must be about to die because you're gonna say something touchy-feely.
You're not gonna die because I need you.
Okay? I need you.
I know.
I love you, too.
Risa, grab another airway.
Dr.
Lorenson, tube out, now.
Be ready to re-intubate.
Okay, I think I see the bleed.
It's in the left mainstem.
Oh, my God.
We intubated the wrong mainstem earlier.
Nobody used the bronchoscope the first time? Dr.
Rorish intubated blind.
Okay.
Thread the new breathing tube over my scope.
Sat's in the 80s.
You ready? I'm ready.
Okay, stand by.
Okay.
Sat 75%.
And I am in.
Dr.
Lorenson, inflate the tube, please.
Good breath sounds on the right, not on the left Just what we want.
Let get some fluids in him, please, and up to the I.
R.
Sat's normalizing.
Dr.
Rorish, we're ready.
Okay.
Jesse, you ready? Save my life, daddy.
All right.
- Sinus rhythm.
- Blood pressure's back.
He's good! He's good.
Oh, my God.
Oh.
Okay, mama.
You're not going anywhere, okay? You're not going anywhere.
Oh, I love you.
Did you find an open bed in the addiction clinic for Mrs.
Eldrich? The way you talked to that woman, Cole, in her state, your temper almost killed her.
- I told her what she needed to hear.
- No.
You told her what you needed her to hear.
We both know what that temper has cost you in the past, son.
I hoped that you when you came here, you'd have put all of that behind you.
I don't need a father-and-son talk from you.
This isn't a father-and-son talk.
This is a senior faculty member telling a new attending that his behavior is unacceptable.
He'll wake up soon.
I'm here, dad.
My friend Mario told me you're gonna be okay.
Eli? Dad.
Don't worry, dad.
I'm gonna take care of you.
Do you have an explanation for what you did today? Not really.
Not really.
That's it? That's an appropriate answer? I was trying to be Mayonnaise.
Mayonnaise? Something Jesse said from that movie, "Officer and a Gentleman.
" They called him Mayonnaise 'cause he's white and his name's Mayo.
I've seen the movie.
I'm talking about I was just trying to do the right thing, man.
For Jesse.
All right.
What about the others? Do they get a pass? This time.
Thank you.
Thank you.
There were, uh, complications with your patient, Jeff, the paramedic.
He's fine, but the bleed was on the left side, not on the right.
I intubated the wrong side? I could have killed him.
Well, you didn't.
I corrected it, so Don't do that, Leanne.
Don't internalize this.
We all make mistakes.
Not like that one.
What is it Jesse says? "Lean on each other.
That's what siblings are for.
" You think he's all you have, but you're wrong, Leanne.
You have me.
You have all of us.
Thank you.
What are you doing? Living.