Miami Medical (2010) s01e11 Episode Script

your patient is in good hands.
Thanks for the update on Tuck.
This one's for free.
Next one-- that'll cost you dinner.
SABLE: Are you asking me out? I am, yes.
How unexpected.
If it's all the same to you, I'm going to hand this arch repair off to Bravo.
The arch repair too much for you? No, I'm good with the repair part.
It's the DUI I'm not nuts about.
I got family issues, that's all.
Ah.
Kelly, I'm making a playlist for the party.
Give me your top ten.
(blows whistle) Not so close to the pier, please! Thank you! Whatever you want, Derek.
Just not too much of that '80s hair-band stuff.
Retro is over.
Ah, well Mom and Dad go out of town for one weekend They said we could have people over.
Yes, but not the entire senior class, Derek.
We graduate from high school exactly one time.
We gotta make a major statement.
And since I'm older By four minutes.
Technically, I'm in charge.
Ooh.
Hot girl at 11:00.
(indistinct chatter) WOMAN: Better take it with you.
MAN: Help! Someone in the water needs help! Derek Help! I need help! Call it in.
(siren whoops) DEREK: Tower 24.
We need immediate medical assistance on the north side.
(static crackles) (siren whoops) Marcus! Is he alive? Ma'am, everything's going to be okay.
Just calm down.
One second.
Face shield.
I got it right here.
Go, go.
I got his chin.
Okay.
Okay.
Oh, my God.
Marcus! (gasping) He's breathing! (coughing) It's all right.
(groans) I'm okay.
(breathes sigh of relief) Try not to talk, sir.
Paramedics are on the way.
Ma'am, how'd you get in the water? We rented one of those power boats, and this big wave hit us like a speed bump and just threw us into the water.
Wait, wait.
So, if you're here, what happened to the boat? (boat engine revving) Right there! Hey.
Hmm.
Chatted with our buddy Tuck this morning.
Yeah? How's his recovery? Guy's been stabbed.
Heart valve transplant, could barely finish a sentence on the phone.
Yeah.
Oh.
I almost called 911 until I realized he was doing sit-ups.
(laughing) Toughest hombre in South Florida.
Either of you happen to catch Proctor this morning? Not yet.
Why? Morning.
An accident near Naples.
Speedboat ran into a pier.
Three red-bands, ten minutes out.
I'm going to need an IV line and a rehydration kit.
Long night? They're all about 12 hours, aren't they? Okay, who's going to do recon? Everything okay? Rehydration kit, Dr.
Proctor.
Nothing that two liters of normal saline won't fix.
Oh.
You-you want Okay.
So, uh How was your evening? You and, uh Dr.
Sable Ow.
Sorry.
Trying to make conversation.
I I-I've never stuck a needle in my boss before.
Wonderful opportunity, don't you think? So, did you get anything from him? Well, if it was a hot date with Dr.
Sable, he's not talking.
Got to respect that.
Heart belongs inside your rib cage, not on your sleeve.
(chuckling) "Men Don't Sleeve" "The Chris Deleo Story.
" Hey, hey.
Heart on sleeve? An injury even we can't fix.
PARAMEDIC: Derek Avelini, 18-year-old male, beach club lifeguard, penetrating neck injury with altered mental status, GCS nine.
(beeping) Kelly Avelini, also 18.
Lost her pulse en route.
She was trapped under the dock and had to be extricated.
Been in V-fib for 11 minutes.
There's a couple; they're hurt.
Yeah, we got 'em, buddy.
Let's go! We gotta move! Carla Salem, 38, blunt-force trauma from a boat crash.
She's altered and unresponsive, possible head and neck injuries; hypothermic on exam.
All right.
Let's get her down to Trauma 3 and have them prep for hypothermic shock.
Medic heard good breathing on both sides.
Thanks.
Oh, and nice smile, Dr.
Zambrano.
Hey, Carla, I'm Dr.
Proctor.
This is Dr.
Zambrano.
Can you hear me? Can you hear me? No purposeful movement.
Weak pulse.
Shallow breathing.
Altered level of consciousness.
Body temperature is 87 degrees-- classic hypothermia.
Let's get her on the Bair Hugger, see if she responds when she warms up.
Body loses heat 200 times faster in water than in air, even in Florida.
Hematoma, left side of forehead.
Possible brain bleed.
Wow.
Feel that.
This thing has got a pulse.
Penetrating neck injury is deep but seems to have missed the major blood vessels.
BP's 90/50 but stable.
He's tachycardic.
Pulse is 160.
Who's watching the beach? It's all right, Derek.
I'm on lifeguard duty now.
I think we got a little hypothermic delirium.
Dr.
Deleo, he's not hypothermic.
His temperature is 108 degrees.
What? 108? Okay, let's get him started on antibiotics.
Temperature that high, it's most likely infection.
Let's get these chest tubes in quick and pack him like a keg on ice before his brain fries to a crisp.
My sister.
Where's my sister? (paddles pummeling) (flatline tone) Still no pulse.
Another mig of epi and atropine.
How long has she been down? 16 minutes.
Recharge.
(electrical whine) Charged.
Clear.
(paddles pummeling) (flatline tone) (sighs) Might be blood around the heart.
I need a 60cc syringe and a spinal needle.
Okay, people, let me in! The chest tubes are in.
Begin cooling.
(groans) The neck surgery's gonna have to wait till we get his oven off of "broil," otherwise he could have a seizure on the table.
Snakes.
What's that? Snakes.
They're on me.
No, no, no.
Derek, Derek.
There's no snakes, all right? We're just flushing cold water into your chest cavity to rapid-cool you.
Can someone survive 108? Not for long.
Snakes! Get them off of me! (grunts) Derek! Derek! (Derek screaming and grunting) (instruments clattering) Get the snakes off me! Sedative! Ten of haldol! (screams) Derek, stop! Listen to me! Listen! There's no snakes, just plastic tubes! (both grunting) Ten cc's haldol! Ten! Hold his legs! (Derek grunting) (panting) (grunting stops) I'll have what he's having.
I'm really sorry about kind of freaking out there.
I'm not thinking straight, am I? It's the high fever.
We're gonna get your temperature down.
You just chill.
Pun intended.
BP's falling.
Temp's still 105.
How can that be? My sister Kelly-- she was at the dock with me.
Yeah, she's here.
Heart rate's 219.
He's losing too much blood.
We got to go to plan B.
We got to explore this neck.
Prep OR 2.
Is he stable enough for surgery? If we don't stop the bleeding, doesn't matter what his temperature is.
Wait.
Wh-Where's my sister? Come on, Kelly.
Come on.
No pulse for 23 minutes.
Dr.
Warren, are you ready to call it? Dr.
Warren? Can anyone here think of anything else we can or should be doing? (flatline tone) (sharp exhale) Time of death:10:42 a.
m.
(flatline tone stops) (exhaling) Twin sister? Pulseless 24 minutes.
I just called it.
Nurse Graceffa, would you prep the death certificate for Dr.
Warren's signature, please? Chris could use a hand on the brother's neck surgery.
Yeah.
I shocked her five times.
I gave her vasopressin.
I even tried tapping the heart.
So, you did everything you could, then.
Sorry.
It's my first time calling time of death.
Do you need a minute? No.
No, I'm fine.
Hey, listen.
Um two guys from the circus go into the pub, and the the lion tamer says to the fire walker, "Wow, walking on coals, that must really hurt.
" And the fire walker says, "The first, sure, but the more you do it, the tougher your feet get.
" So the lion tamer says, "So it doesn't hurt at all?" And the fire walker says, "Are you kidding? It's walking on hot coals.
" Carla Salem from the boat accident.
Did we find next of kin? She was with someone at the scene.
Looks like he was sent to the ER.
We have a name? I'll track it down ASAP.
He's been asking for you.
We meet again.
Not sure we met the first time.
I heard you were the best; I didn't also expect "best-looking.
" That line-- for the record-- DOA.
I try to keep the bar low; that way, you won't be disappointed.
Any lower, you trip over it.
(chuckles) Well, it was nice to meet you, uh "Flerrferferer"? Gotta work on my penmanship.
I'm Rick.
Medevac pilot.
Down from Sarasota.
Eva.
Trauma doc.
Up from Little Havana.
Hey, Chris! DELEO: What the hell you doing here? I had a run down from the coast, thought I'd say yo.
Then I got to talking with Eva.
(Deleo chuckles) Yeah, I'll bet you did.
Did I miss something here? Eva Zambrano meet, uh, Rick Deleo, my brother.
Big brother.
Don't.
You buried the lead, Rick.
Yeah.
CT scans are ready, Dr.
Zambrano.
So what is it, huh? What, what do you need? You need money? How much do you need? Easy, bro, I don't need a loan.
Besides, that was just the one time.
No, no, try three.
Two.
Three.
Business is booming right now.
I don't need your money.
So then what? What is it? I mean, there's always some kind of reason with you.
My chopper has a warning light on the rotor gearbox.
Waiting on a part, couple hours max.
You sold Zambrano short, bro.
I wasn't trying to sell her.
For the record, you and Eva? It's like a little league team taking on the Yankees.
Then you won't mind me taking a few practice swings.
(scoffs) That bump is actually a dilated temporal artery.
A pseudo-aneurysm.
It's dangerous, and it needs to be sorted out in the OR, but the priority right now is trauma workup.
I've been very impressed with Dr.
Sable's work.
Are you part of a tag team? (chuckles) You came in with the symptoms.
I was just making a diagnosis.
It was fun.
Just didn't take, that's all.
ZAMBRANO: The scans are clear; no intracranial bleeding.
No sign of brain trauma, no neck injury, no spinal injury.
Why the hell is she still unconscious? Dr.
Proctor? Yeah? Carla Salem's next of kin-- in the waiting room.
Right.
All right, who's here to see Carla Salem? I am.
I am.
Who are you? I'm Marcus.
I'm Carla's boyfriend.
Who the hell are you? I'm Greg, Carla's husband.
GREG: Carla and I have been separated for about nine months.
The divorce won't be final for another few weeks.
She said she was going away with the girls for the weekend.
She wasn't ready to tell you about us, which is why your people shouldn't have called him.
Carla was on vacation with me.
Well, she may have been "with" you, but she is still the mother of my kids.
Listen, she's still on Greg's insurance plan, so our people notified him as "next of kin," right? Carla? Oh, my God, Greg Marcus? What's happening? Carla, I'm Dr.
Proctor.
You're in a trauma hospital in Miami.
You had an accident.
MARCUS: It's okay.
Everything's gonna be okay.
No, it's it's not okay.
I-I I can't feel my legs! So, Rick's your brother, huh? You never mention him.
You two close? (chuckling): What, you didn't you pick up on our "brotherly loathe"? Vascular clamp.
We, uh we talk twice a year, and fight twice a year.
(rapid beeping) Derek's heartbeat's irregular again.
His temp's up to 106.
Damn it.
It's not an infection.
Why do you think his body's having such a severe reaction? Huh.
Hey, take a gander.
What are we looking at? It's a fiberglass splinter.
Probably from the boat hull.
If that penetrated all the way to his thyroid gland The thyroid hormones would flood his body, causing his metabolism to go into overdrive.
Dr.
Warren what we have here is a real, live thyroid storm.
(bell dings) A couple Propylthiouracil meds will reverse the hyperthyroid state in no time.
DELEO: Thyroid storm.
That's a first for me.
I've read about them, but I've never actually seen one.
Called my first time of death today.
His twin sister.
That's rough.
My first TOD: I'd been an intern for all of about ten minutes.
This guy stumbles in, falls down the waiting area and just-just bleeds out right there on the floor.
And I'll never forget what the great Dr.
Rayner said to me in that moment.
What? I'm kneeling next to the body, and, uh he glowers down at me with that voice of his, he says, "Get up.
" There's a gunshot wound in Trauma Two.
" What did you do? Oh, I got up, went into Trauma Two and I pulled three bullets out of a guy.
Gotta keep moving.
Well, listen, your CT scans show no signs of brain trauma or back fractures-- obvious spinal injury, which is what you would expect with paralysis.
So, what is causing this? We don't know yet.
We're gonna have to do a spinal tap, see if we can get any more information.
(breathes deeply) I know.
But to be quite frank with you, at the moment, you're a bit of a puzzle.
Well, am I one of those 500-piece puzzles, or am I one of those 10,000-piece puzzles? I'll let you know when I put it together.
So, any preexisting conditions we should know about? No.
Anything unusual happen to you recently? Other than getting mowed down by a boat and, um and my ex-husband showing up? What a mess! Just a mess! Not on the itinerary, huh? It's just, Marcus and I started dating two months ago, and we decided to get away for the weekend.
I wasn't ready to tell Greg that I'd that I'd met someone else.
You must think I'm terrible.
'Cause you went on vacation with your boyfriend? Mm.
Someone call the cops.
(laughs) What are you doing? According to this, my blood pressure is 0/0.
Is that bad? Well, for starters, you're using a pediatric cuff.
Do you have a problem with high blood pressure? You're the doctor, you tell me.
Mm, perfectly normal, 120/80.
Then that's your medical opinion? Yes.
Good.
Then you're now my doctor, so we have confidentiality, right? If that's a pickup line, it's the weirdest one yet.
Eva, I don't need a date I need a doctor.
So, you wanted privacy.
Ah I went to a clinic in Fort Myers last Saturday.
They took an X ray.
Said there might be something on my kidney, but it was inconclusive.
I'd like a second opinion.
I guess it's probably just a kidney stone.
That's what I was told.
But you should still have it checked out.
I know a great specialist in town.
I'm not showing my kidneys to just anyone.
Chris says you're the best.
I'm a trauma surgeon.
It's you or I ignore the problem.
Then you'll feel so guilty, we'll end up having pity sex like in some bad movie of the week.
(chuckles) You Deleo boys, real romantics.
All right, well, uh, why don't we start by taking your blood.
That should tell us a lot.
Eva, it's very important this stays between us, doctor and patient.
I don't want Chris involved.
Can you do that for me? DEREK: A thyroid storm? Profuse sweating rapid pulse, temperatures as high as 108 in your case.
We gave you medication to treat it, and you should be well on your way to a full recovery.
Your neck injury should resolve nicely.
What about my sister? How's she doing? Is she all right? Derek Wait.
Wha what? When Kelly came in, she wasn't breathing.
She had no pulse.
I couldn't restart her heart.
I'm so sorry.
I'm only doing this as a favor because you're Chris's brother.
But, uh you really need to see a doctor locally.
But I like your bedside manner.
(chuckles) Squeeze.
So what's the story with you and Chris? The story? Um he's a good friend and colleague.
I might ask you the same question.
You want his version or mine? Well, there's always two sides to a story, so might as well start with yours.
We were hyper-competitive.
Lot of headlocks, always shoving each other's face in the mud.
We had different operating systems.
And he claims I slept with Bonnie Brizzolara.
His senior prom date.
Did you? What kind of guy do you think I am? I have no idea what kind of guy you are, Rick.
Kiss me.
What? What the hell was that? Chris? (bell dings) Chris! Chris! Not what it looked like.
It's exactly what it looks like.
Yankees, bro.
Sorry, really.
I didn't want him to see you taking my blood.
Yeah, well, you do that again, and there will be blood.
Yours everywhere.
PROCTOR: T-5 C-3 (knocking) Yeah? L-2 Oh! Now that is the result of a wasted youth in the pubs of Oxfordshire.
You paged? Were you with a patient? Sort of.
How's your head? Oh, it's not my head I'm worried about.
How would someone who presents with hypothermia and a normal CT end up with paralysis? Spinal tap? Came back clear.
We know she had a head injury because the impact on her forehead Causing the dilated artery.
But the scans showed no sign of a bleed or a swelling, no neck, no obvious spinal trauma.
By a process of elimination, we end up with SCIWORA: spinal cord injury without radiographic abnormality.
In which case, the paralysis is almost certainly permanent.
PROCTOR: With SCIWORA, there's injury to the cord from the impact of the trauma, but without visible fracture to the spine itself.
If it's SCIWORA, the paralysis is? It's irreversible.
So we're talking about, um, wheelchairs and, uh.
catheters? May I have a few minutes alone with Carla? Yeah, of course.
I would trade places with her in a heartbeat if I could.
I believe you would.
It's hard to say just when a relationship dies.
We just woke up one morning and They do say divorce is like a death, even if it's mutual.
Dr.
Proctor, something's wrong.
What's happening? She's having a seizure.
Push two migs of lorazepam.
Fellas, you might want to wait in the hall.
A seizure? Yeah, it's strange.
See this blood? She must have bitten her tongue.
(rapid beeping) Yeah, look at that.
Look, there are multiple tongue lacerations.
This one's already started healing.
Which would explain why she arrived unconscious.
She must have had a seizure before she ever got here.
Dr.
Proctor.
Wow.
It must have ruptured from the seizure.
We're gonna have to remove that thing before she bleeds out.
Get her up to the OR and page me when she's on the table.
DELEO: Derek how're you feeling? Your parents are on their way.
They should be here in a couple of hours.
I brought over a social worker, but he wouldn't talk to her.
He's just had major surgery, and his sister just died.
It's gonna take time to recover, you know? Physically and emotionally.
His temperature's coming down.
That's good.
But his heart rate and breathing are still rapid.
The thyroid meds should have stabilized that by now.
The propranolol drip is running, and Endocrinology is about to start their iodine treatment.
He's gonna be okay, Serena.
His family has already lost one child.
I don't want them to lose another.
I understand.
You've had a rough day.
But you do need to separate your emotions from the patient's.
You need to find a way to be okay with it.
I'm not.
I'm not okay with it.
And I don't know when I'm gonna be okay with it, okay? So, what are we looking for today? Oh, your blood work showed some abnormalities consistent with kidney stones.
This scan should confirm the diagnosis.
Stay very still.
Try not to speak, okay? Hard as that may be.
I'd say "okay," but I'm not allowed to speak.
(knocking) Hey.
Hey.
How's your thyroid storm? You're talking about my brother, right? (chuckles) Look, if you and Rick want to I don't want to get in the way of anything, okay? So if you want to No, no, no, no No, no, no, no, you don't owe me any explanations.
There's no "me and Rick," Chris.
All right.
Just I can perform an emergency thoracotomy, my BP doesn't flinch.
but my brother shows up, and shh it just spikes to 2,000/90.
I-I know there's a lot of history, but maybe you should just sit down, talk to each other.
There's a, there's a golden hour in every relationship, right? A time when you can still make repairs.
Sometimes I think that Rick and I think we just missed that window.
(computer beeps) The guy's in bad shape, huh? The mass right there Mm.
it's kidney cancer.
(pager beeping) Derek.
Kidney cancer.
Ain't that a hornet's nest? It's stage two.
It's treatable.
Not the worst diagnosis.
Not the best either, right? I, um, I have some referrals in Fort Myers.
Just use my name.
Now that I've given you a second opinion, here's a third: Tell your brother.
Sorry, not happening.
Are all you Deleos this stubborn? You asked me before about my version of the relationship.
Now I'll give you his.
Chris was always pulling my fat out of the fire.
When I got in the bar fight, he bailed me out of jail.
When I drank too much, he got me sober.
When Mom almost lost the house, he paid off the whole damn mortgage.
Notice how he gets all the active verbs.
Just once, I'd like to be the big brother.
Thanks for the CT, Eva.
So that's it? You just disappear? (sighs) Always leave 'em wanting more.
(bell dings) Marcus! Marcus, um, we're taking Carla up to the OR.
We don't think this is the first seizure she's had, so No, I, uh I can't have this conversation.
What? Look, Dr.
Proctor, I can't do this.
What do you mean? Carla and I, we're a-a a midlife fling.
I'm the "fun guy," I'm not the, uh change-your-catheter- twice-a-day guy.
(bell dings) Just, uh This is not what I signed up for.
Can you tell, Carla, uh Tell her, tell her something.
KATHY: Dr.
Proctor, the OR's ready for you.
What happened there? The, uh the "fun guy" left.
(rapid beeping) What's going on? His lungs are filling with fluid; Derek's going into heart failure.
All right, give him 40 migs of lasix and start a dopamine drip.
(rapid beeping) Lost his pulse.
Damn it! It's V-fib.
Push a mig of epi and charge to 360.
God! Want me to take it? No.
Serena, come on, take a break.
I got it.
Serena! I got this! Paddles to me.
Clear.
(rhythmic beeping) GRACEFFA: Normal sinus rhythm.
Strong pulse.
He's back.
Great.
Now, what the hell was that? Derek's coronary arteries were clean on angiography.
Which means he had heart failure but not a heart attack.
Well, heart failure can occur with thyroid storm.
Except that there would have been a venous hum in the right jugular, which I didn't hear.
The base of the left ventricle is contracting normally, but there's weakened contraction in the middle and upper portions.
You have a theory? I think Derek's heart is, um, is way out on his sleeve.
Sorry, I was finishing Carla Salem's surgery.
Did you page me? Yeah.
18-year-old recovering from thyroid storm.
Had heart failure.
WARREN: Heart's enlarged at the ventricular apex.
Coronaries? Clean.
It wasn't a heart attack.
And? And his, uh, his twin sister died today.
So I'm thinking Takotstubo cardiomyopathy.
Broken heart syndrome.
Well, there aren't many documented cases.
Isn't that diagnosis reserved for bereaved spouses? Not necessarily.
See, a heart races when you're in love, and it stills when you're in mourning.
Losing a twin sister would certainly qualify.
I'd just really like to believe otherwise.
That relationships in our lives have a profound physical effect on us.
Yeah, for better and worse.
You'll need to increase the contractility of the heart using dobutamine.
Losing a sibling is a traumatic event.
The heart can only do so much to protect itself.
So the surgery went well, and we've had your MRI scans back.
And I've got some good news, Carla.
It appears you don't have SCIWORA.
You have something called Todd's paralysis.
That's good news? PROCTOR: It is, it's great news.
See, it's a post-seizure temporary condition during which the body recovers from the trauma.
Temporary? Mm-hmm.
You were already in a state of Todd's paralysis when you arrived.
And the healing laceration on your tongue-- that was the missing piece of the puzzle that indicated that you'd had a a post-concussive seizure immediately after the accident.
And in time, the paralysis will subside.
But you will-- you really will recover full function of your legs.
Carla! Really? Um, Marcus left.
But you're still here.
Even when you thought it was permanent.
I'm I'm your husband.
Yeah.
(laughing) Broken heart syndrome? What, so so it's all in my head? No, far from it.
Um, broken heart syndrome is a a very real weakening of the heart muscle.
It's brought on by profound emotional loss.
Much like yours.
WARREN: We gave you blood pressure medication to reduce the workload on your heart while you recover.
(sighing): Kelly was my other half.
You know, all those, all those stupid fights-- over who got the bigger room or who-whose turn it was to get the car (sighs) Derek's parents are on the way from the airport.
Thanks, Kathy.
Is there anything else we can do for you? Anyone you want to talk to? Well, can I, can I talk to you? I mean, you know, you were with her, right? At the end? I was.
Um, well, if-if-if you're okay with that? Yeah.
I'm okay.
Tell me about Kelly.
So any wild plans tonight that I can envy? Oh.
I'm sorry that, uh, you and Dr.
Sable didn't take.
It's not that it didn't take.
It's that I didn't take it.
Which is pretty much par for the course if you ask a certain woman in Baltimore.
You want to talk? No, I don't want to talk.
I could measure a drink, but I tried that last night, and it didn't help.
What were you drinking? Pepper vodka.
Hmm.
Try mojitos.
Good night.
(text message tone) Hey! Hey! Heading out? Yeah, I got to get back.
Just wanted to say that I'm sorry if I was a An ass? No, if I accused you of having an ulterior motive in coming here.
I mean, if you do need money I don't, but thank you.
I'm sorry, too.
About Bonnie Brizzolara.
Oh, you-- you son of a bitch! (laughing) I knew it.
Be fair.
It was two weeks after prom, after she had already dumped you.
She said that? No, no, no, I dumped her.
(both laughing) (grunts) It's history, right? Ancient history.
Maybe, um Thanksgiving? Maybe we both go home and get in a little sport fishing? Drive Mom crazy playing the old Fender and Yamaha? Full tilt, huh? Sure.
That sounds good.
Come here.
RICK: Eva, wait.
Sorry, I I got a text from Rick saying come up to the roof.
I wanted to give you a proper good-bye.
Tell him for me, okay? Just wait till my skids are up.
("Hopelist" intro playing) I hope if I happen to go So, Thanksgiving.
Thanksgiving.
Be safe.
(helicopter door closes, rotor whirring) Chris, uh I have something to tell you.