ER s01e22 Episode Script
House of Cards
Doug? Doug, you slept through the alarm.
Doug? Come on .
Jake's gonna be up soon .
Come on, you're gonna get me started .
Two nights in a row, huh? -Didn't you need the bathroom? -No, there's one at work.
l'll lock it, okay? -You forgot to lock it yesterday.
-Okay.
-l'll see you .
-Later.
Carter, pick up the film on O'Shields.
Chen, do the med renewals.
l have to start on the Sub-l evaluations.
Placements aren't until next month .
-l need your procedure books.
-l thought we had until next week.
You did .
Now you don't.
ls that a problem? You've been here longer.
You've done more procedures.
-How many intubations? -Four or five.
-Chest tubes? -Lost count.
Did a femoral cutdown .
-You didn't.
-Oh, but l did .
-How long have you had this pain? -Since Friday.
Bowling night.
-When l can't bowl l'm not happ y.
-Well, we want you happ y.
Chem-7, CBC, LFTs and an abdominal ultrasound .
-An ultrasound? -Could be appendicitis.
-Could be gas.
-ls there a problem? -How are you, sir? -Not too good .
Stomachache.
-Kept him from bowling .
-That's a shame.
Mr.
McDowall, this is Dr.
Swift, our attending physician .
Cancel the CBC, Chem-7, LFTs and ultrasound .
-What's your diagnosis? -Probably gastroenteritis.
Why order $ 1 000 worth of tests? -To rule out appendicitis.
-lt's ruled out.
He has pain in the right lower quadrant.
So would you if you were full of gas.
Sir, go home and take nothing by mouth for six hours.
When you do, take little sips of clear fluid .
lf it gets worse.
.
.
.
.
.
you come back and see us immediately, all right? -You'll be there to get her moved? -l'll be there.
l'll tell her she's going to the home.
Listen, Jackie, l .
.
.
.
l wanna be the one to tell her.
Please, Jackie.
All right.
-Petey! -Hey, Ma.
-Hey, Ma.
How are you feeling? -l'm leaving today.
l've been trying to make my hair up the way Daddy liked it.
-Could you help me, honey? -Ma.
.
.
.
Jackie and l and the doctors.
.
.
.
.
.
think you need more care than we can give you .
You need to have someone around all the time to make sure that you're okay.
We found this great place.
The Melville Home.
We'll make it just as nice as your house, Mama.
-Jackie's gonna make you curtains.
-Yellow stripes, your favorite.
Do l have to go, Peter? Yeah, Ma.
You do.
-Swift was way out of line.
-He was right.
-You should talk to him.
-What for? -You still want the attending? -He's made up his mind .
-What do we have? -What do you want for bloods? He works for the electric company.
Took a 20-foot fall .
High-current burns.
Doug, thanks.
Let's start a central line.
Okay, Carter, over here.
-Ever done a central line? -l've seen one.
You're gonna do one now.
Put the long 1 4-gauge on the 6cc syringe.
Prep 5 migs morphine.
-Give him a liter of Ringer's first.
-Aim at the sternal notch .
Now you have blood refill .
Remove the syringe.
-Will do.
-And feed the guide wire through .
Lucky guy.
No ST changes.
-Slide it into the subclavia.
-You want a tetanus? -300ccs Ringer's.
-He needs a Foley.
-Here are the x-rays.
-They'll do that upstairs.
We have enough guide wire left to pull it through .
-You're doing a central line? -Yep .
Now get an x-ray to check the placement.
-Excellent.
-Get him ready for transfer.
-Talk to me.
-He fell from a utility pole.
Circumferential third-degree burns to upper extremities.
No cardiac changes.
C-spine, chest, pelvis all negative.
-No long bone fractures.
-Let's get him up .
-Any fever, Mrs.
Ryan? -Just the headache and dizziness.
-l think l'm going to throw up .
-And nausea.
We'll get you fixed up right away.
-What's wrong with her, doctor? -lt's probably just a flu bug .
Her heart rate is a little fast, so we'll run some tests.
Put her on a monitor and let's check a rhythm strip .
-A monitor? -Yeah, a heart monitor.
-ls it that serious? -We'll just keep our eye on her.
Are these tests gonna cost a lot of money? -You have insurance, don't you? -No.
We'll work something out.
How long have you had that cough? -You can give me medicine, okay? -How long, Mrs.
Salazar? A week.
Two.
Have you been coughing anything up, like blood? lt's not so bad .
l have to go.
Could you have been exposed to tuberculosis? -Tuberculosis? -l don't know what you mean .
Does anyone else in your family have this cough? Anybody you work with? l don't work, okay? Mi esposo has green card, he work.
My children are at home, l need to go.
Have any of them been sick? Fevers? Night sweats? My daughter.
l have to go home.
Mi madre, she take care of her now.
lf your daughter's sick and you have tuberculosis, we need to see her.
lt's very contagious.
l can't make you stay, Mrs.
Salazar.
But l would strongly advise you to take these tests.
No questions asked, okay? Okay, l stay a little bit.
-What's she so afraid of? -She's probably illegal .
Lydia? We gotta get Mrs.
Salazar into an isolation room.
She needs a chest x-ray, acid-fast stain and sputum culture.
-Carter, try and find her a mask.
-Sure.
Stay away from me, Shirley.
You could've killed Mr.
Munchy.
lt was your fault, Sari .
You said the road was clear.
Didn't say it would stay that way.
l told you to step on it.
-lt's not safe to speed .
-You were going five miles an hour! -Shut up ! This is all your fault! -Two sisters.
Slow-moving MVA.
One with a nose lac, the other dizzy with headache.
The only danger they're in is from each other.
Thanks.
Somebody, help ! Please, please! -Narrow complex tachycardia.
-Rate 200.
Start a line and give O-2.
Get the crash cart now! -My God ! What's happening? -You're gonna have to stay back.
-BP's 70 over 50.
-Give me some adenosine.
Janette, you have to help me out.
Blow on your thumb.
Blow on it really hard .
-Two milligrams of adenosine? -Three, lV push .
-There's no BP.
-l can't feel a pulse.
She's out.
Set it on 50.
Hit the synch switch .
-Turn up the O-2, 1 5 liters.
-Stand back.
She's in V-fib.
Turn off the synch and charge to 1 00 joules.
-Clear? -Clear.
-l get a BP.
1 00 over 60.
-Normal sinus rhythm.
-Pulse bounding .
-lt means she's okay.
Welcome back, kiddo.
You're gonna be okay.
Your mom's right here.
You're fine.
A-R-Q-P-T-X.
That was completely wrong .
Why don't you try the same line with your glasses? Oh, yes.
Here we go.
N-T-O-A-W-R.
Damn it, Shirley.
l can't see squat.
l'm gonna kill you .
We've lived together for 50 years and l'm not dead yet.
You're a bully! -Now l'm blind .
Are you happ y? -Ladies, please.
-She's no lady.
-Hold still .
l'm concerned about your vision and headache.
You need a C AT scan .
Which glasses are yours? How should l know? l can't see.
Why don't you try these? Here.
l thought you'd be older.
-Young man .
.
.
.
-Just one second .
Carter.
Got a procedure for your book.
-Pelvic.
-l already have a ton of pelvics.
Lady asked for you personally.
l'm so thirsty.
Some water, please.
There you go.
So Janette has supraventricular tachycardia.
Like a short circuit in her heart.
So she needs to be admitted into Cardiology.
Someone from Social Services will help you apply for Medicaid .
Your daughter's gonna be fine, Mrs.
Ryan .
Just fine.
-Lunch later? -Yeah, sure.
-Cafeteria or the vending machines? -Doesn't matter.
Wild Willie wants you to see the lady in Three.
-Have you talked to him yet? -No.
Don't plan to.
She's in her 8th month .
Has stomach cramps, frequent urination .
-Why don't you take it? -Why? Because l asked you to.
-Do l know you from someplace? -No.
-Why did you ask to see me? -You treated my friend Barbara.
She recommended you .
The truth is l don't really have cramps.
Why are you here, Mrs.
Blum? Barbara has been trying to have a baby for years.
Last month she came in with cramps and you examined her.
And the very next week she got pregnant.
-Did l have something to do with it? -Barbara thinks so.
When she heard that we were trying she said, ''Go and see Dr.
Carter.
He's got the magic touch !'' Dr.
Greene? Your name's on the board for that pregnant woman .
-Why is Dr.
Lewis with her? -l gave it to her.
l see.
l understand you lost a mother during delivery.
Jodi O' Brien .
Preeclampsia.
She bled out.
l'd like you to present it at the case conference today.
-Two o'clock.
-l need time to prepare.
No, you don't.
You know what happened .
Mrs.
Salazar, your tests are positive for tuberculosis.
We need to get your family in here as soon as possible.
-l bring them mañana.
-No, today, Mrs.
Salazar.
You shouldn't leave the hospital .
You're very sick.
l feel better, really.
l can go.
Do you understand the seriousness of your illness? l don't care if you're illegal .
l want to make sure your kids are okay.
-They're fine.
-You'll infect everybody around you .
-Your children, people you work with .
-Dr.
Greene.
Your family needs to come in and be seen in this hospital ! Mark.
What's the matter with you? She's leaving with TB.
l'm not supposed to be angry? -She can't trust you if you scream.
-l wasn't screaming .
-Now you're screaming at me.
-Forget it.
lf she leaves, she leaves.
Well, rule out sepsis.
We made a suprapubic tap .
-You're kidding? -Step right up, doc.
-Temp's 1 02.
-Any luck with the urine? l gave him four ounces of clear fluid and then four more.
Eight ounces? Dry as a bone.
-lsn't there some other way? -This is the easiest way.
Carter, swab the area.
Hold the syringe in one hand .
lt's okay, kiddo.
-Palpate the pubic symphysis.
-What now? We use a small needle to get a urine sample.
-Careful not to push too hard .
-How do you know it's too hard? That's probably too hard .
-Your husband brought you in? -The old fuddy-duddy.
He thinks l have paranoid psychosis with elaborated delusional systems.
He reads too much, that's all .
-Do you ever hear voices? -Of course not.
-Ever have frightening thoughts? -No.
Are you afraid someone will harm you? Of course.
Streets aren't safe nowadays, are they? -Do you have a psychiatrist? -Yes.
Would you like his number? Let's see, where did l put it? Just give me a second here.
Yikes.
.
.
.
SlG Sauer 228.
Nine millimeter double action, Little heavy, but lethal .
Would you mind if l gave this to Security, just for now? Not at all .
l've still got the Beretta.
-Still here? -Waiting for the ambulance.
-How are you, Ma? -She's been quiet.
Let me talk to her.
Ma, you're gonna like the place.
l saw it.
lt's nice and clean .
You have your own TV in your room.
There's a little courtyard outside.
l've got surgery.
Jeanie's gonna go with you now.
l'll come by later, okay? l love you, Ma.
We're ready.
-Hey.
-Here, Dr.
Greene.
-Conference? Are you nervous? -No.
l love an inquisition .
-You'll do fine.
-Are you kidding? -They'll be out for blood .
-We've all been there.
How many young mothers have you killed, Doug? Mark, listen .
Hey.
Sorry l can't be there today, but you're gonna do okay.
Good luck.
Excuse me? -ls there a conference here at two? -Not enough space.
lt's moved .
-Oh, yeah? What room? -The auditorium.
-Finger lac in Two.
-l have to finish the med renewals.
-Got enough lacs in your book? -l told you l'm busy.
Carter, why in the hell did you give Mrs.
Baba water? -The lady in Two.
-She was thirsty.
She was NPO .
Scheduled for surgery.
No food, no water.
-She was your gallbladder patient? -Just read the chart.
Now, because of you she can't have surgery.
l'm doing a small bowel .
Chen, scrub in .
To the O .
R.
? Really? Good, you're here.
l hope it's instructive.
For the other residents.
Down there.
Do you know the diagnostic criteria for preeclampsia? Blood pressure greater than 1 40 over 90, proteinuria and edema.
-She had proteinuria.
-l attributed it to a urinary infection .
-Her pressure was only high once.
-You should've checked again .
My index of suspicion should've been higher.
l treated her seizure with magnesium sulfate and Ativan .
-What about the ultrasound? -l missed the placental abruption .
The AFl and profile were excellent.
There was normal fundal placement.
-Yet she abrupted .
-There were no clinical signs.
No vaginal bleeding, shock, abdominal pain or fetal distress.
What are the criteria for vaginal delivery? Favorable fetal lie and a small baby under 4,000 grams.
The baby was 9 lbs, 3 ounces.
Macrosomic.
l used the Leopold maneuver and fundal height to estimate baby size.
l was off.
What were the risks of using forceps? -A 23 % risk of shoulder dystocia.
-Which happened .
What qualifies you to manage high risk OB? We're not here to question Dr.
Greene's training .
-Why a C-section in the ER? -Baby was hypoxic and bradycardic.
There was a risk of brain damage.
-Have you done crash C-sections? -l've scrubbed in .
l give Dr.
Greene credit for crashing her.
What would you have done differently? l should've taken her up to OB myself.
lmmediately.
l've induced before, delivered babies before.
l assumed l could handle the situation .
l was wrong .
Anyone else? Thank you, Dr.
Greene.
That wasn't too bad .
l knew once you had a chance to talk it through you'd feel fine.
l'm supposed to feel some sense of relief? l gotta get back to work.
By the way, that stomach flu this morning .
.
.
.
The next time you disagree with me don't do it in front of the patient.
Where are we going? Follow me.
Hold that a second .
-What do you think? -lt's a little small for you .
-Whose is it? -Yours.
-Mine? -Doug .
.
.
.
-lt's the same as yours.
-Eighteen-speed grip twist-shifter.
Hyper-sprocket drive and stuff l know nothing about.
Hey, come here.
You ride bike, you wear helmet.
Where's your helmet? l know you mean well, but.
.
.
.
-Come on, Doug .
Race you .
-You're on .
You should've talked to me about this.
l'll be back.
-Where's Anita Salazar? -Eloped .
Can't find her.
-Want me to send Public Health out? -lt's probably a fake address.
Mark, we've got an MVA coming in .
Rollover TC, thrown 20.
Heavy ETOH.
Lac on right leg, no fracture.
He doesn't want to be touched .
Calls himself Smiley.
No l .
D.
-l'm in the wrong place.
-Get a portable down here.
-Get CBC, Chem-7, blood alcohol .
-Watch his neck.
Transfer, one, two, three.
All right.
-BP 90 over 50.
-Get him undressed .
-Hit your head? Does it hurt? -How should l know? -Run the saline wide open .
-Drunk as a skunk.
Cap refill's slow.
He's hypovolemic.
-Do you think it's the spleen? -Don't know.
Shoot a cross-table C-spine.
CBC, type and cross for four.
Stay still, Mr.
Smiley.
-X-ray's ready.
-Lungs clear.
-Shooting .
-Stand back.
Hold your breath .
Clear.
O-2 is here.
-Get your hands off me! -Abdomen's rigid .
lt's the spleen .
Let's prep for a lavage.
Smiley, we need to make sure you're not bleeding internally.
We're gonna take this tube and put it in your nose and into your stomach .
-lt's not pleasant.
-Go to hell ! lt's not the highlight of my day either.
Don't come near me with no tube.
-One percent X ylocaine with epi .
-You're drunk out of your mind .
We need to take care of you .
This is our decision, not yours.
Just keep breathing .
l assisted on a laparotomy and closed the incision .
Two new procedures.
Finally l have a chance.
Can l get you anything, Haleh? Coffee? Cake? -You wanna get me coffee? -Sure.
Cream and sugar.
-Where are we putting Fareau? -Exam 2.
And if you could, here's a list of procedures l still need .
-lf any come in throw them my way? -Sure.
You can help Wendy get an lV going on our junkie friend in Two.
-lV is not on my list.
-lt is now.
-Maybe we should get a doctor.
-l'll find a vein .
l always do.
There's one.
No good .
-l'll get Dr.
Lewis.
-What for? He hasn't got a vein anywhere.
He's gonna need a central line.
He's bleeding out.
We've gotta find the source.
-How's that lavage? -Almost there.
Gotta find the bleeder.
lt could be retroperitoneal .
He's feeling it.
More lidocaine.
-Where's he bleeding? -No output yet.
-Hang two units now.
-This is soaked through .
-Will four units be enough? -Get four more.
Found it! -Femoral artery.
-lt's a pumper.
Get Vascular on the line, get an angiogram and let's get him up .
-l'll keep pressuring .
-Call the Cath Lab.
Let's move! Deb? Almost done.
.
.
.
There.
Are you crazy? You're not allowed to do a central line! lt seemed so easy.
-You get in trouble, l'll get fired .
-lt's fine.
Look.
Oh, my God .
-Where's the.
.
.
.
? -What's wrong? -What's going on? -Where's the guide wire? You lost the wire? Deb, where is it? There it is.
Cath lab, stat.
What happened? Deb, what happened? -l need a cath lab.
-Oh, my God .
-Come on, Carter, move.
-We need to snare it.
-Get a fluoroscope.
Order an echo.
-Call Transport to take him up .
Deb? Deb, wait a minute.
Deb, wait! -You found Deb? -There's no answer at her house.
-l almost feel responsible.
-You didn't nearly kill a patient.
-Carter.
Where's Chen? -l have no idea.
Find her.
Swift wants to talk to her.
-How's the patient? -Well, we got the wire out.
Whether or not we'll be sued is another story.
-You shouldn't have bought Jake that bike.
-Why not? He has one.
-He wanted it.
-He doesn't get everything he wants.
-l'll take it back.
-You miss the point.
-A 1 2-year-old hit by a delivery truck! -l'll be right there.
-l wanted to do something nice.
-lt's too much, too soon .
-He doesn't know what it means.
-Neither do l .
-You can't go through him to get to me.
-You think that? That's what he hopes you're doing .
-Doug, Trauma 1 ! -1 2-year-old ran through red light.
Hit and thrown 20 feet.
LOC at scene.
BP 60 over 40.
l think he's got left pneumo.
Name's Billy Schmoo.
Jennifer left? l can't believe you didn't tell me.
l wasn't gonna announce it over the intercom.
-What did you tell Rachel? -l took the high road on that one.
Nothing .
l don't think l can bear losing her.
-l hardly see her as it is.
-Yeah .
Well, that's kind of the problem, isn't it? With Jennifer.
Not just Rachel .
-She wants to be in Milwaukee.
-So what? Figure something out.
Call her, go see her.
l'm going this weekend .
lt's so like a guy to wait four days.
Go tonight.
-l work tomorrow.
-l'll cover tomorrow.
l owe you .
Thanks.
-Tendon reflexes are normal .
-Lacerations look superficial .
-Pulse thready at 1 50.
-He looks dusky.
Tension pneumo.
Eighteen-gauge.
Set up a pleuravac.
Pulse ox is 65.
-CBC, Chem-7.
-Where are the parents? -How many units O-neg? -Six.
Get a 1 2-lead .
Cross-table C-spine and a portable chest.
He's on his way.
-What size? -28 French .
Here's the chest-tube tray.
-Here we go.
-One percent lidocaine.
Belly's soft.
Bowel sounds normal .
Blood's drawn .
Lab's here.
-Get that chest tube ready.
-Call down the H and H.
Cap refill is not great.
Still dusky.
All right.
Breath sounds are good but his BP is crashing .
Distant heart sounds, dilated neck veins.
Prep for pericardiocentesis.
Twenty cc's per kilo, start with a 300cc bolus.
BP's falling, 40 palp .
Come on, now.
Damn it.
-Where are you, little heart? -Too far.
-lt's okay.
-Call Respiratory.
Come on .
Come on, little heart.
l know you're in there somewhere.
-Got it.
-Yeah, that's much better.
Okay.
Call O .
R.
and the Thoracic team.
-BP? -Coming up .
60 over 40.
Cross-table C-spine.
Let's get a chest film.
You're gonna be just fine, buddy.
-We'll take him up .
-Great.
Are you okay? Heading home.
What's not to be okay? -Pepperoni or salami? -What? -Pepperoni or salami on your pizza? -Salami .
Too bad, l win .
All right, but only on one third .
Okay.
See you in a bit, babe.
Bye.
Pizza will be there in 20 minutes.
-Thanks.
-For what? -For staying .
-Well, you're buying the pizza.
Look at your Daddy.
That silly hat.
l am so tired .
Ma, why don't you get some sleep? Let me take this.
Peter? Do you still want to be a doctor? Ma.
.
.
.
l am a doctor.
Your talent is God's gift to you .
What you do with it is your gift back to God .
-Go ahead .
Get some sleep .
-Okay.
Hi, Jen .
How are you? Rach? Good .
l wanna come up and see you guys.
l wanna talk.
No, no.
Tonight.
How about tomorrow? Okay.
We'll see you Saturday.
Rachel there? No, no, no, don't wake her.
l miss her.
Jen, l love you .
You there? Yeah .
Okay.
Sorry.
Chloe? Hi, Susie.
Let's go to the kitchen .
l really didn't care about the patient.
l just wanted the procedure.
-By tomorrow everybody will forget.
-l won't.
-l'm quitting .
-You can't.
-Sure l can .
-Deb, listen .
You're smart, you learn fast.
-lt's about taking care of people.
-You're gonna be a great doctor.
l don't really like it.
That's not completely true.
l like the science of it.
But the patients, the sickness.
.
.
.
Sometimes it almost scares me.
lt scared the hell out of me.
When l was a kid my older brother was sick.
ln and out of the hospital .
When l saw the doctors l knew it was what l wanted to do.
That's the difference, John .
You think about treating patients.
You take the time to talk to them.
You listen to them.
You care.
So what are you gonna do? Join the party.
My parents' wedding anniversary.
l'll wait to tell my folks afterwards.
Mother will throw up .
Should be fun .
Thanks.
Mark, you've got visitors.
Mrs.
Salazar.
Hi .
-My madre, Maria.
-Hi, Maria.
-My niña, Christina.
-Hi .
You're the sick one, huh? You guys grab the bags, huh? Here.
Eat this, it'll warm you up .
-l don't want to trouble you .
-Yeah, right.
-Ronnie sold my stuff.
-You're kidding .
l'm shocked .
You were so right about him.
-You were right about all of them.
-Yeah, well .
.
.
.
They're all basically the same person .
That is not true.
Norm was a good guy.
Sure.
The two hours of the day he was awake.
Chloe.
.
.
.
What did you do to my coat? Hitched a ride with this family.
Kid got car sick.
l switched to ultra lights.
You've seen a doctor for the baby, haven't you? A couple of times.
.
.
.
-Once.
-Recently? Sort of.
l am so glad to be here, Susie.
l'm glad you're okay.
-Sort of.
-Sort of.
l'm so tired .
l know.
l'm scared, Susie.
Don't worry, Chloe.
Don't worry.
We'll be okay.
We'll be okay.
Doug? Come on .
Jake's gonna be up soon .
Come on, you're gonna get me started .
Two nights in a row, huh? -Didn't you need the bathroom? -No, there's one at work.
l'll lock it, okay? -You forgot to lock it yesterday.
-Okay.
-l'll see you .
-Later.
Carter, pick up the film on O'Shields.
Chen, do the med renewals.
l have to start on the Sub-l evaluations.
Placements aren't until next month .
-l need your procedure books.
-l thought we had until next week.
You did .
Now you don't.
ls that a problem? You've been here longer.
You've done more procedures.
-How many intubations? -Four or five.
-Chest tubes? -Lost count.
Did a femoral cutdown .
-You didn't.
-Oh, but l did .
-How long have you had this pain? -Since Friday.
Bowling night.
-When l can't bowl l'm not happ y.
-Well, we want you happ y.
Chem-7, CBC, LFTs and an abdominal ultrasound .
-An ultrasound? -Could be appendicitis.
-Could be gas.
-ls there a problem? -How are you, sir? -Not too good .
Stomachache.
-Kept him from bowling .
-That's a shame.
Mr.
McDowall, this is Dr.
Swift, our attending physician .
Cancel the CBC, Chem-7, LFTs and ultrasound .
-What's your diagnosis? -Probably gastroenteritis.
Why order $ 1 000 worth of tests? -To rule out appendicitis.
-lt's ruled out.
He has pain in the right lower quadrant.
So would you if you were full of gas.
Sir, go home and take nothing by mouth for six hours.
When you do, take little sips of clear fluid .
lf it gets worse.
.
.
.
.
.
you come back and see us immediately, all right? -You'll be there to get her moved? -l'll be there.
l'll tell her she's going to the home.
Listen, Jackie, l .
.
.
.
l wanna be the one to tell her.
Please, Jackie.
All right.
-Petey! -Hey, Ma.
-Hey, Ma.
How are you feeling? -l'm leaving today.
l've been trying to make my hair up the way Daddy liked it.
-Could you help me, honey? -Ma.
.
.
.
Jackie and l and the doctors.
.
.
.
.
.
think you need more care than we can give you .
You need to have someone around all the time to make sure that you're okay.
We found this great place.
The Melville Home.
We'll make it just as nice as your house, Mama.
-Jackie's gonna make you curtains.
-Yellow stripes, your favorite.
Do l have to go, Peter? Yeah, Ma.
You do.
-Swift was way out of line.
-He was right.
-You should talk to him.
-What for? -You still want the attending? -He's made up his mind .
-What do we have? -What do you want for bloods? He works for the electric company.
Took a 20-foot fall .
High-current burns.
Doug, thanks.
Let's start a central line.
Okay, Carter, over here.
-Ever done a central line? -l've seen one.
You're gonna do one now.
Put the long 1 4-gauge on the 6cc syringe.
Prep 5 migs morphine.
-Give him a liter of Ringer's first.
-Aim at the sternal notch .
Now you have blood refill .
Remove the syringe.
-Will do.
-And feed the guide wire through .
Lucky guy.
No ST changes.
-Slide it into the subclavia.
-You want a tetanus? -300ccs Ringer's.
-He needs a Foley.
-Here are the x-rays.
-They'll do that upstairs.
We have enough guide wire left to pull it through .
-You're doing a central line? -Yep .
Now get an x-ray to check the placement.
-Excellent.
-Get him ready for transfer.
-Talk to me.
-He fell from a utility pole.
Circumferential third-degree burns to upper extremities.
No cardiac changes.
C-spine, chest, pelvis all negative.
-No long bone fractures.
-Let's get him up .
-Any fever, Mrs.
Ryan? -Just the headache and dizziness.
-l think l'm going to throw up .
-And nausea.
We'll get you fixed up right away.
-What's wrong with her, doctor? -lt's probably just a flu bug .
Her heart rate is a little fast, so we'll run some tests.
Put her on a monitor and let's check a rhythm strip .
-A monitor? -Yeah, a heart monitor.
-ls it that serious? -We'll just keep our eye on her.
Are these tests gonna cost a lot of money? -You have insurance, don't you? -No.
We'll work something out.
How long have you had that cough? -You can give me medicine, okay? -How long, Mrs.
Salazar? A week.
Two.
Have you been coughing anything up, like blood? lt's not so bad .
l have to go.
Could you have been exposed to tuberculosis? -Tuberculosis? -l don't know what you mean .
Does anyone else in your family have this cough? Anybody you work with? l don't work, okay? Mi esposo has green card, he work.
My children are at home, l need to go.
Have any of them been sick? Fevers? Night sweats? My daughter.
l have to go home.
Mi madre, she take care of her now.
lf your daughter's sick and you have tuberculosis, we need to see her.
lt's very contagious.
l can't make you stay, Mrs.
Salazar.
But l would strongly advise you to take these tests.
No questions asked, okay? Okay, l stay a little bit.
-What's she so afraid of? -She's probably illegal .
Lydia? We gotta get Mrs.
Salazar into an isolation room.
She needs a chest x-ray, acid-fast stain and sputum culture.
-Carter, try and find her a mask.
-Sure.
Stay away from me, Shirley.
You could've killed Mr.
Munchy.
lt was your fault, Sari .
You said the road was clear.
Didn't say it would stay that way.
l told you to step on it.
-lt's not safe to speed .
-You were going five miles an hour! -Shut up ! This is all your fault! -Two sisters.
Slow-moving MVA.
One with a nose lac, the other dizzy with headache.
The only danger they're in is from each other.
Thanks.
Somebody, help ! Please, please! -Narrow complex tachycardia.
-Rate 200.
Start a line and give O-2.
Get the crash cart now! -My God ! What's happening? -You're gonna have to stay back.
-BP's 70 over 50.
-Give me some adenosine.
Janette, you have to help me out.
Blow on your thumb.
Blow on it really hard .
-Two milligrams of adenosine? -Three, lV push .
-There's no BP.
-l can't feel a pulse.
She's out.
Set it on 50.
Hit the synch switch .
-Turn up the O-2, 1 5 liters.
-Stand back.
She's in V-fib.
Turn off the synch and charge to 1 00 joules.
-Clear? -Clear.
-l get a BP.
1 00 over 60.
-Normal sinus rhythm.
-Pulse bounding .
-lt means she's okay.
Welcome back, kiddo.
You're gonna be okay.
Your mom's right here.
You're fine.
A-R-Q-P-T-X.
That was completely wrong .
Why don't you try the same line with your glasses? Oh, yes.
Here we go.
N-T-O-A-W-R.
Damn it, Shirley.
l can't see squat.
l'm gonna kill you .
We've lived together for 50 years and l'm not dead yet.
You're a bully! -Now l'm blind .
Are you happ y? -Ladies, please.
-She's no lady.
-Hold still .
l'm concerned about your vision and headache.
You need a C AT scan .
Which glasses are yours? How should l know? l can't see.
Why don't you try these? Here.
l thought you'd be older.
-Young man .
.
.
.
-Just one second .
Carter.
Got a procedure for your book.
-Pelvic.
-l already have a ton of pelvics.
Lady asked for you personally.
l'm so thirsty.
Some water, please.
There you go.
So Janette has supraventricular tachycardia.
Like a short circuit in her heart.
So she needs to be admitted into Cardiology.
Someone from Social Services will help you apply for Medicaid .
Your daughter's gonna be fine, Mrs.
Ryan .
Just fine.
-Lunch later? -Yeah, sure.
-Cafeteria or the vending machines? -Doesn't matter.
Wild Willie wants you to see the lady in Three.
-Have you talked to him yet? -No.
Don't plan to.
She's in her 8th month .
Has stomach cramps, frequent urination .
-Why don't you take it? -Why? Because l asked you to.
-Do l know you from someplace? -No.
-Why did you ask to see me? -You treated my friend Barbara.
She recommended you .
The truth is l don't really have cramps.
Why are you here, Mrs.
Blum? Barbara has been trying to have a baby for years.
Last month she came in with cramps and you examined her.
And the very next week she got pregnant.
-Did l have something to do with it? -Barbara thinks so.
When she heard that we were trying she said, ''Go and see Dr.
Carter.
He's got the magic touch !'' Dr.
Greene? Your name's on the board for that pregnant woman .
-Why is Dr.
Lewis with her? -l gave it to her.
l see.
l understand you lost a mother during delivery.
Jodi O' Brien .
Preeclampsia.
She bled out.
l'd like you to present it at the case conference today.
-Two o'clock.
-l need time to prepare.
No, you don't.
You know what happened .
Mrs.
Salazar, your tests are positive for tuberculosis.
We need to get your family in here as soon as possible.
-l bring them mañana.
-No, today, Mrs.
Salazar.
You shouldn't leave the hospital .
You're very sick.
l feel better, really.
l can go.
Do you understand the seriousness of your illness? l don't care if you're illegal .
l want to make sure your kids are okay.
-They're fine.
-You'll infect everybody around you .
-Your children, people you work with .
-Dr.
Greene.
Your family needs to come in and be seen in this hospital ! Mark.
What's the matter with you? She's leaving with TB.
l'm not supposed to be angry? -She can't trust you if you scream.
-l wasn't screaming .
-Now you're screaming at me.
-Forget it.
lf she leaves, she leaves.
Well, rule out sepsis.
We made a suprapubic tap .
-You're kidding? -Step right up, doc.
-Temp's 1 02.
-Any luck with the urine? l gave him four ounces of clear fluid and then four more.
Eight ounces? Dry as a bone.
-lsn't there some other way? -This is the easiest way.
Carter, swab the area.
Hold the syringe in one hand .
lt's okay, kiddo.
-Palpate the pubic symphysis.
-What now? We use a small needle to get a urine sample.
-Careful not to push too hard .
-How do you know it's too hard? That's probably too hard .
-Your husband brought you in? -The old fuddy-duddy.
He thinks l have paranoid psychosis with elaborated delusional systems.
He reads too much, that's all .
-Do you ever hear voices? -Of course not.
-Ever have frightening thoughts? -No.
Are you afraid someone will harm you? Of course.
Streets aren't safe nowadays, are they? -Do you have a psychiatrist? -Yes.
Would you like his number? Let's see, where did l put it? Just give me a second here.
Yikes.
.
.
.
SlG Sauer 228.
Nine millimeter double action, Little heavy, but lethal .
Would you mind if l gave this to Security, just for now? Not at all .
l've still got the Beretta.
-Still here? -Waiting for the ambulance.
-How are you, Ma? -She's been quiet.
Let me talk to her.
Ma, you're gonna like the place.
l saw it.
lt's nice and clean .
You have your own TV in your room.
There's a little courtyard outside.
l've got surgery.
Jeanie's gonna go with you now.
l'll come by later, okay? l love you, Ma.
We're ready.
-Hey.
-Here, Dr.
Greene.
-Conference? Are you nervous? -No.
l love an inquisition .
-You'll do fine.
-Are you kidding? -They'll be out for blood .
-We've all been there.
How many young mothers have you killed, Doug? Mark, listen .
Hey.
Sorry l can't be there today, but you're gonna do okay.
Good luck.
Excuse me? -ls there a conference here at two? -Not enough space.
lt's moved .
-Oh, yeah? What room? -The auditorium.
-Finger lac in Two.
-l have to finish the med renewals.
-Got enough lacs in your book? -l told you l'm busy.
Carter, why in the hell did you give Mrs.
Baba water? -The lady in Two.
-She was thirsty.
She was NPO .
Scheduled for surgery.
No food, no water.
-She was your gallbladder patient? -Just read the chart.
Now, because of you she can't have surgery.
l'm doing a small bowel .
Chen, scrub in .
To the O .
R.
? Really? Good, you're here.
l hope it's instructive.
For the other residents.
Down there.
Do you know the diagnostic criteria for preeclampsia? Blood pressure greater than 1 40 over 90, proteinuria and edema.
-She had proteinuria.
-l attributed it to a urinary infection .
-Her pressure was only high once.
-You should've checked again .
My index of suspicion should've been higher.
l treated her seizure with magnesium sulfate and Ativan .
-What about the ultrasound? -l missed the placental abruption .
The AFl and profile were excellent.
There was normal fundal placement.
-Yet she abrupted .
-There were no clinical signs.
No vaginal bleeding, shock, abdominal pain or fetal distress.
What are the criteria for vaginal delivery? Favorable fetal lie and a small baby under 4,000 grams.
The baby was 9 lbs, 3 ounces.
Macrosomic.
l used the Leopold maneuver and fundal height to estimate baby size.
l was off.
What were the risks of using forceps? -A 23 % risk of shoulder dystocia.
-Which happened .
What qualifies you to manage high risk OB? We're not here to question Dr.
Greene's training .
-Why a C-section in the ER? -Baby was hypoxic and bradycardic.
There was a risk of brain damage.
-Have you done crash C-sections? -l've scrubbed in .
l give Dr.
Greene credit for crashing her.
What would you have done differently? l should've taken her up to OB myself.
lmmediately.
l've induced before, delivered babies before.
l assumed l could handle the situation .
l was wrong .
Anyone else? Thank you, Dr.
Greene.
That wasn't too bad .
l knew once you had a chance to talk it through you'd feel fine.
l'm supposed to feel some sense of relief? l gotta get back to work.
By the way, that stomach flu this morning .
.
.
.
The next time you disagree with me don't do it in front of the patient.
Where are we going? Follow me.
Hold that a second .
-What do you think? -lt's a little small for you .
-Whose is it? -Yours.
-Mine? -Doug .
.
.
.
-lt's the same as yours.
-Eighteen-speed grip twist-shifter.
Hyper-sprocket drive and stuff l know nothing about.
Hey, come here.
You ride bike, you wear helmet.
Where's your helmet? l know you mean well, but.
.
.
.
-Come on, Doug .
Race you .
-You're on .
You should've talked to me about this.
l'll be back.
-Where's Anita Salazar? -Eloped .
Can't find her.
-Want me to send Public Health out? -lt's probably a fake address.
Mark, we've got an MVA coming in .
Rollover TC, thrown 20.
Heavy ETOH.
Lac on right leg, no fracture.
He doesn't want to be touched .
Calls himself Smiley.
No l .
D.
-l'm in the wrong place.
-Get a portable down here.
-Get CBC, Chem-7, blood alcohol .
-Watch his neck.
Transfer, one, two, three.
All right.
-BP 90 over 50.
-Get him undressed .
-Hit your head? Does it hurt? -How should l know? -Run the saline wide open .
-Drunk as a skunk.
Cap refill's slow.
He's hypovolemic.
-Do you think it's the spleen? -Don't know.
Shoot a cross-table C-spine.
CBC, type and cross for four.
Stay still, Mr.
Smiley.
-X-ray's ready.
-Lungs clear.
-Shooting .
-Stand back.
Hold your breath .
Clear.
O-2 is here.
-Get your hands off me! -Abdomen's rigid .
lt's the spleen .
Let's prep for a lavage.
Smiley, we need to make sure you're not bleeding internally.
We're gonna take this tube and put it in your nose and into your stomach .
-lt's not pleasant.
-Go to hell ! lt's not the highlight of my day either.
Don't come near me with no tube.
-One percent X ylocaine with epi .
-You're drunk out of your mind .
We need to take care of you .
This is our decision, not yours.
Just keep breathing .
l assisted on a laparotomy and closed the incision .
Two new procedures.
Finally l have a chance.
Can l get you anything, Haleh? Coffee? Cake? -You wanna get me coffee? -Sure.
Cream and sugar.
-Where are we putting Fareau? -Exam 2.
And if you could, here's a list of procedures l still need .
-lf any come in throw them my way? -Sure.
You can help Wendy get an lV going on our junkie friend in Two.
-lV is not on my list.
-lt is now.
-Maybe we should get a doctor.
-l'll find a vein .
l always do.
There's one.
No good .
-l'll get Dr.
Lewis.
-What for? He hasn't got a vein anywhere.
He's gonna need a central line.
He's bleeding out.
We've gotta find the source.
-How's that lavage? -Almost there.
Gotta find the bleeder.
lt could be retroperitoneal .
He's feeling it.
More lidocaine.
-Where's he bleeding? -No output yet.
-Hang two units now.
-This is soaked through .
-Will four units be enough? -Get four more.
Found it! -Femoral artery.
-lt's a pumper.
Get Vascular on the line, get an angiogram and let's get him up .
-l'll keep pressuring .
-Call the Cath Lab.
Let's move! Deb? Almost done.
.
.
.
There.
Are you crazy? You're not allowed to do a central line! lt seemed so easy.
-You get in trouble, l'll get fired .
-lt's fine.
Look.
Oh, my God .
-Where's the.
.
.
.
? -What's wrong? -What's going on? -Where's the guide wire? You lost the wire? Deb, where is it? There it is.
Cath lab, stat.
What happened? Deb, what happened? -l need a cath lab.
-Oh, my God .
-Come on, Carter, move.
-We need to snare it.
-Get a fluoroscope.
Order an echo.
-Call Transport to take him up .
Deb? Deb, wait a minute.
Deb, wait! -You found Deb? -There's no answer at her house.
-l almost feel responsible.
-You didn't nearly kill a patient.
-Carter.
Where's Chen? -l have no idea.
Find her.
Swift wants to talk to her.
-How's the patient? -Well, we got the wire out.
Whether or not we'll be sued is another story.
-You shouldn't have bought Jake that bike.
-Why not? He has one.
-He wanted it.
-He doesn't get everything he wants.
-l'll take it back.
-You miss the point.
-A 1 2-year-old hit by a delivery truck! -l'll be right there.
-l wanted to do something nice.
-lt's too much, too soon .
-He doesn't know what it means.
-Neither do l .
-You can't go through him to get to me.
-You think that? That's what he hopes you're doing .
-Doug, Trauma 1 ! -1 2-year-old ran through red light.
Hit and thrown 20 feet.
LOC at scene.
BP 60 over 40.
l think he's got left pneumo.
Name's Billy Schmoo.
Jennifer left? l can't believe you didn't tell me.
l wasn't gonna announce it over the intercom.
-What did you tell Rachel? -l took the high road on that one.
Nothing .
l don't think l can bear losing her.
-l hardly see her as it is.
-Yeah .
Well, that's kind of the problem, isn't it? With Jennifer.
Not just Rachel .
-She wants to be in Milwaukee.
-So what? Figure something out.
Call her, go see her.
l'm going this weekend .
lt's so like a guy to wait four days.
Go tonight.
-l work tomorrow.
-l'll cover tomorrow.
l owe you .
Thanks.
-Tendon reflexes are normal .
-Lacerations look superficial .
-Pulse thready at 1 50.
-He looks dusky.
Tension pneumo.
Eighteen-gauge.
Set up a pleuravac.
Pulse ox is 65.
-CBC, Chem-7.
-Where are the parents? -How many units O-neg? -Six.
Get a 1 2-lead .
Cross-table C-spine and a portable chest.
He's on his way.
-What size? -28 French .
Here's the chest-tube tray.
-Here we go.
-One percent lidocaine.
Belly's soft.
Bowel sounds normal .
Blood's drawn .
Lab's here.
-Get that chest tube ready.
-Call down the H and H.
Cap refill is not great.
Still dusky.
All right.
Breath sounds are good but his BP is crashing .
Distant heart sounds, dilated neck veins.
Prep for pericardiocentesis.
Twenty cc's per kilo, start with a 300cc bolus.
BP's falling, 40 palp .
Come on, now.
Damn it.
-Where are you, little heart? -Too far.
-lt's okay.
-Call Respiratory.
Come on .
Come on, little heart.
l know you're in there somewhere.
-Got it.
-Yeah, that's much better.
Okay.
Call O .
R.
and the Thoracic team.
-BP? -Coming up .
60 over 40.
Cross-table C-spine.
Let's get a chest film.
You're gonna be just fine, buddy.
-We'll take him up .
-Great.
Are you okay? Heading home.
What's not to be okay? -Pepperoni or salami? -What? -Pepperoni or salami on your pizza? -Salami .
Too bad, l win .
All right, but only on one third .
Okay.
See you in a bit, babe.
Bye.
Pizza will be there in 20 minutes.
-Thanks.
-For what? -For staying .
-Well, you're buying the pizza.
Look at your Daddy.
That silly hat.
l am so tired .
Ma, why don't you get some sleep? Let me take this.
Peter? Do you still want to be a doctor? Ma.
.
.
.
l am a doctor.
Your talent is God's gift to you .
What you do with it is your gift back to God .
-Go ahead .
Get some sleep .
-Okay.
Hi, Jen .
How are you? Rach? Good .
l wanna come up and see you guys.
l wanna talk.
No, no.
Tonight.
How about tomorrow? Okay.
We'll see you Saturday.
Rachel there? No, no, no, don't wake her.
l miss her.
Jen, l love you .
You there? Yeah .
Okay.
Sorry.
Chloe? Hi, Susie.
Let's go to the kitchen .
l really didn't care about the patient.
l just wanted the procedure.
-By tomorrow everybody will forget.
-l won't.
-l'm quitting .
-You can't.
-Sure l can .
-Deb, listen .
You're smart, you learn fast.
-lt's about taking care of people.
-You're gonna be a great doctor.
l don't really like it.
That's not completely true.
l like the science of it.
But the patients, the sickness.
.
.
.
Sometimes it almost scares me.
lt scared the hell out of me.
When l was a kid my older brother was sick.
ln and out of the hospital .
When l saw the doctors l knew it was what l wanted to do.
That's the difference, John .
You think about treating patients.
You take the time to talk to them.
You listen to them.
You care.
So what are you gonna do? Join the party.
My parents' wedding anniversary.
l'll wait to tell my folks afterwards.
Mother will throw up .
Should be fun .
Thanks.
Mark, you've got visitors.
Mrs.
Salazar.
Hi .
-My madre, Maria.
-Hi, Maria.
-My niña, Christina.
-Hi .
You're the sick one, huh? You guys grab the bags, huh? Here.
Eat this, it'll warm you up .
-l don't want to trouble you .
-Yeah, right.
-Ronnie sold my stuff.
-You're kidding .
l'm shocked .
You were so right about him.
-You were right about all of them.
-Yeah, well .
.
.
.
They're all basically the same person .
That is not true.
Norm was a good guy.
Sure.
The two hours of the day he was awake.
Chloe.
.
.
.
What did you do to my coat? Hitched a ride with this family.
Kid got car sick.
l switched to ultra lights.
You've seen a doctor for the baby, haven't you? A couple of times.
.
.
.
-Once.
-Recently? Sort of.
l am so glad to be here, Susie.
l'm glad you're okay.
-Sort of.
-Sort of.
l'm so tired .
l know.
l'm scared, Susie.
Don't worry, Chloe.
Don't worry.
We'll be okay.
We'll be okay.