ER s02e18 Episode Script
A Shift in the Night
E.
R.
Previously on E.
R.
- Is that alcohol on your breath? - Champagne.
It's grounds for expulsion.
It's none of your business.
We made a decision.
That's final.
No way.
No way! No! No! She's my baby, Susan, and I want her back.
I'm adopting her.
- The family had a right to know.
- You're right.
- You made a mistake.
- Why don't you just get out? Peter, Doug can handle this.
Go on.
Go on.
"A Shift In the Night" bringing you traffic and weather on the 1.
Rain all over Chicagoland today.
The rain continues to come down causing flooding on I-94 and other expressways.
The WMAQ weather calls for the rain to continue into tonight and it stays in our forecast through tomorrow.
Bring an umbrella, raincoat and life preserver- Son of a bitch.
Son of a bitch! Please leave a message at the tone.
Mark? Mark, if you 're there, it's Kerry Weaver.
Could you pick up? We got a little problem.
Neal Hansen's on tonight but his mother-in-law died, so The answer is no, Kerry.
I am not coming in.
I don't care if his mother-in-law died, okay? I've been on three nights in a row.
Tell Morgenstern that I can't and give the shift to Doug Ross.
He could use the money.
What do you mean, whiplash? No evidence of fracture or dislocation.
Vertebral bodies are in good alignment.
There is, however, reversal of cervical lordosis suggesting the possibility of acute cervical ligamentous injury.
My headache tripled during that dissertation.
Does the name Evelyn Wood mean anything to you? You know, Doug, I like you in that collar.
It's a good look.
Bold, yet spiritual.
No, I'm stopped dead at the stoplight and this Pakistani cabdriver plows into me.
I get out.
He doesn't speak a word of English.
I look at his photo ID and it's some sandy-haired guy named Kroopf.
Kroopf? Isn't that kind of a German name? - Can I have your shoes? - What? Can I have your shoes? Mine are sopping wet.
Sure, Mark, absolutely.
You know, I'll just walk home barefoot in the rain.
- Sorry.
I would've taken that shift- - No problem at all, Doug.
I've only worked graveyard the last three nights.
Got off at 8:00 this morning drove to Milwaukee to spend the day with Rachel only to have Jennifer tell me that she got the dates mixed up.
See, Rachel, it turns out, is on some Brownie troop camping trip.
So I drove back, three and a half hours this time because of the heavy rain and flooding on I-94.
And here I am, refreshed and full of enthusiasm for my work.
Are you on tonight? Go with God.
- Why are these patients in the hallway? - No beds.
- You're on tonight, right? - No, dinner with my lawyer at 7:00.
Dr.
Lewis, a Peter Kreidman called.
Can't make dinner till 7:30.
- Oh, 7:30.
- Can you change that to tomorrow night? Hansen's out, Doug has got whiplash Benton's in some marathon surgery and Kerry and I will be short-handed.
Mark, I'm sorry, I can't.
Chloe's gonna try and fight this adoption.
I can't miss this.
- Mark, I was afraid I'd miss you.
- You're leaving too? - I've been on 14 hours.
- I've been on the last three nights.
I'd stay, but Morgenstern wants me to present our QA at the JCAH in the morning.
Whoever handled it dropped the ball.
I'll be up all night pulling it together.
- It's a real mess.
- Yeah, I was handling it.
I'll walk you through it once I get it straightened out.
Shall we make rounds? Mr.
PCP is sleeping it off.
Probably needs another six hours.
Second-degree burns, both hands.
Checking pot roast, forgot hotpads.
Gangbanger in a fistfight.
- Fistfight? That's quaint.
- Waiting on x-rays.
hand and foot spasms.
CMV retinitis, PCP pneumonia, Gl lymphoma, waiting on ICU.
Rule-out Ml.
Waiting on Cardiology consult.
Calls himself Bobby Darin, claims he got a shark bite while in the pool at the Four Seasons Hotel.
Waiting on Psych.
Ten-centimeter laceration sustained while sliding into second.
Needs sutures.
Abdominal pain, probably food poisoning, but Surgery's ruling out an appy.
Severe shoulder pain and nosebleed.
Platelet count, 15,000.
Waiting on Hematology.
TPA patient on dopamine.
Pulmonary edema.
Intubated on a nitro drip.
Waiting on ICU.
Bicycle versus postal truck.
Multiple rib fractures bilateral hemopneumothoraces.
Critical but stable.
Let me guess.
ICU? Anaphylactic shock and septic shock.
I think that's about it.
How are things in Glocca Morra? Unbelievable.
It's been like this since the rain started.
- Who else is on besides me? - A few Residents, a Psych intern and maybe Carter.
Good night.
LOL with burned hands admitted to burn service films on that gang kid were negative, sent him home and the rule-out appy was ruled out and discharged.
Excellent, Haleh, you get three gold stars.
Carter? I have sutured the leg lac in 4, knee lac in 3, arm lac in 2 and head lac in 1.
That's it? All right.
We have seven waiting for ICU.
Make it eight.
Bounce-back hip replacement with DVT and PE.
We have 33 in the ER and 41 in the waiting room.
Make that 42.
Paramedics pulling in with an altered LOC.
Your mission, should you choose to accept it which you will, because you have no choice is to move these folks out so we can move these folks in.
I want quick turnover.
No big workups.
No unnecessary labs, x-rays or consults.
And no comments.
Carol, Carter, let's go meet the incoming.
Randi, I want a turkey sandwich from the cafeteria because Jerry isn't here yet.
Sorry, I'm late.
And I can't be responsible for him, Dr.
Greene.
Let me out of here! - Hi, Chuny.
You're late.
- I'm on at 8:00.
It's 8:04.
What have we got? Omar Gandera, 15.
Strolling down by The Loop, drunk out of his mind.
Vitals are stable.
BP, 120/80.
Fell on his knees.
He needs stitches.
- Are you guys having a party? - Don't start, Doris.
- How much did you drink, Omar? - Don't touch me! Get out of here! - Can I give Mrs.
Layton more Demerol? - How long has it been? - Three hours.
- All right, if you help with this kid.
All right.
On my count.
One, two, three.
- Put me down! - Buckle him up tight.
Party on.
- Let me out of here! - Sinus tach at 110.
- Carter, what do you want to do? - BP's still 120/80.
CBC, Chem-7, blood alcohol, tox screen ABG and saline.
Wide open.
- Carter, she said tie him tight.
- I did! - Labs are back on the kid with the fever.
- Any films? - Not yet.
- Go sit on Radiology and don't bug me until you've got everything.
- Carter, get the labs going.
I'll be back.
- Oh, yeah.
We're having some fun now.
There are non-displaced oblique fractures of the third and fourth metatarsal shafts with no significant angulation or comminution.
The foot's busted, okay? Splint him and ship him out.
- What are you doing? - Gonna fix his feet.
What did he do, stick them in a blender? No more mixed drinks.
Put him on the back burner.
We've got people who are a lot worse.
- Could you take a look at my mother? - In a minute.
What a mess, huh? It's not helped by the fact you were late.
- Are you the doctor in charge? - The one and only.
My son has a horrible cut on his hand.
- We'll get to him as soon as we can.
- I'll bring him in.
Jerry, can you take her to the waiting room? It's bleeding.
We've been waiting out there.
- Come on, ma'am.
- Jerry? Don't let people sneak in.
Whoever's out there has been triaged.
We'll see them as soon as we can.
No one gets in - unless they're dying.
- Right.
Malik? Mrs.
Votey, you're having weakness in your right arm? Yesterday and again today.
Everything's sort of out of focus.
- At one point she couldn't even speak.
- Scared my students half to death.
- My mother teaches self-defense.
- To seniors.
Squeeze.
Maybe I could just wait here for my regular doctor.
- Dr.
Randall.
Jack Randall.
- I know him.
Mrs.
Votey, you might be experiencing what we call TIAs transient ischemic attacks.
They can be a warning sign of impending stroke.
I'll call Dr.
Randall but in the meantime I'll admit you upstairs where they can work you up.
Start her on heparin, 800 an hour call Randall and get her admitted to Medicine.
- You want a CT first? - Let them do it.
We need the room.
I don't get it.
He's still altered - but his tox screen's negative.
- I have to pee.
- Ethanol? - None detected.
- PH? -7.
30.
- Omar, what did you drink? - I've got to pee.
Omar? - I gotta pee.
- Go ahead and pee.
There's a tube in your bladder.
Paramedics five minutes out.
Drive-by shooting.
- Who's on call for Trauma? - Shall I call Benton? - No.
Call Thoracic.
- Thoracic? You heard me.
Call Morgenstern, tell him we are closing the Trauma now.
- Lytes? - Not back yet.
- What's wrong with the lab tonight? - Same thing as us.
There's just too many patients.
Okay.
Say he has a gap.
Methanol, uremia, DKA.
Ethylene glycol? - You think he drank antifreeze? - Well, gotta rule it out.
Get a Wood's lamp.
- It's really jammed in there.
- What? I said, it's really jammed in there! - Carter, what are you doing? - Foreign body in the canal.
Have him lie down.
- Do you know what it is, sir? - What? A bead.
Carter, you having fun paying your penance in the ER? I'm off Surgical Service I'm working nights in the ER.
What's not to be happy about? It's better than not graduating.
I thought Dr.
Hicks might suspend me.
She would if she could have.
I can't believe I was that stupid, drinking on call.
I can.
You're a medical student.
Superglue? Yes.
Just touch the bead.
Hit the skin, you're in trouble.
- Don't move! - Don't move! Dr.
Greene, the paramedics are here.
Got it! - How old is she? -18 months.
Two gunshots to the right upper leg.
Hypotensive.
Can't get a line.
It's okay, baby.
We're here.
Cops got the boy who did it.
Black kid, 14 years old.
Shot him dead.
Can't say I'm sorry.
- Cops never mind shooting a black kid.
- And he didn't mind shooting this one.
CBC, type and cross for two.
Get a unit of O-neg.
Right foot's cold.
No pulse.
- Femoral artery.
- I'll call for x-rays.
Sixteen-gauge Jamshidi.
One percent with epi.
Faint pulse.
Dynamap's not reading.
One-twenty of saline.
Fill these tubes.
Haleh, page Netzley.
- Malik, you're gonna take her up to O.
R.
- You got it.
Dr.
Greene, about closing Trauma, Morgenstern gave the big "N-O.
" - Get him on the phone for me.
- He went back up to Surgery.
- All right, I'll find him.
- Mark, bingo on Omar.
You got it? I want Daddy! - Ethylene glycol it is.
- What's that? Antifreeze.
Get Renal down here stat.
- Let's give him IV ethanol.
- We don't have any.
What? I checked.
Pharmacy's out.
St.
Luke's is sending us some, but it won't be here for another hour.
There's a bottle of bourbon out in that shopping cart in the hall.
- Bourbon? -120 cc oral loading dose.
Thirty cc's POQ one hour.
Otherwise, he's got brain damage and renal failure.
Bourbon shooters it is.
Labs are finally back on that coma in 2.
It's DKA.
Start an insulin drip, - Mrs.
Votey had another TIA.
- She's supposed to be at Medicine.
- Dr.
Randall said to discharge her.
- Discharge her? Is he nuts? Page him 911 and tell him to get in here now.
Here you go- Who let this dog in here? Try taking it away and it bites you.
- That puker in 4 is still at it.
-10 of Compazine and a liter of saline.
- Mr.
Nathan in 5, he's- - Morgenstern is up at the front.
What about the turkey sandwich? - I can get it almost immediately.
- Who are we talking about? Mr.
Nathan in 5, high white count temp's 101, has left lower-quadrant pain.
Probably diverticulitis.
Give him amp, gent, Flagyl and get an abdominal series.
That's right.
Bring him in.
- Answering the phones? - I'm here to help.
Then why don't you close up the Trauma? Sorry, Mark.
County's looking for excuses to put us out of business.
Well, it's 10:30.
We've got enough business to last a year.
-32 in the ER, 49 in the waiting room.
- Look, Mark, I'm sorry.
Got a little Benton fracas in Trauma 2.
Board of Commissioners wants to close an ER and save $80 million a year.
Every time we close, we're saying that we're not capable of providing.
Well, we're not.
I now have nine ICU patients draining my staff we've no monitored beds.
Here are the films on Robinson.
I can't even help half the patients here.
It's insane.
I talked to the critical care coordinators.
We move six patients from ICU to Telemetry, but we're staying open.
So what? He's oxygenating well.
The tube heads medially, striking the mediastinum.
Peter, Shelly.
- Why didn't you page me? - Shelly's handling it.
- I'm on call for Trauma.
- We didn't need you.
- If you don't want help during- - Gentlemen, please.
Ladies! I don't hear anybody helping here.
What's going on? Third-year Surgical Resident Leung placed the chest tube anteriorly.
- Which has relieved the pneumothorax.
- But will not drain the hemothorax.
Which can be repositioned when we prep.
Excellent idea! Let's all scrub in.
Come on, folks.
Let's go.
- If you need anything, give me a call.
- How about a turkey sandwich? Too late.
Cafeteria closes at 10 now.
County cutbacks.
It's a piece of cartilage that doesn't turn to bone until you're grown-up.
- Dr.
Greene.
- Carter.
Chloe.
Hi, Mark.
I came here to see Susie, but John says she's not on tonight.
No, she isn't.
Chloe was curious about how to read an x-ray.
I guess the interest in medicine must run in the family.
Yeah, right.
Junior gymnast in 5.
Fractured patella.
Time to break the bad news.
That hand is so little.
- Look at that.
- It's probably 4 or 5 years old.
Little Susie's hand is about that big, right? So Susie probably told you what's going on with us.
Yeah, she mentioned some things.
I understand why she's upset with me.
I never thought I could change, why should she? I just want her to see that things are different now, that I'm different now.
- Did she tell you that I'm engaged? - No, she didn't.
He's a great guy.
Steady.
He's as smart as Susie is.
He's the only person, besides Susie, who's ever taken the time with me to get to know me, you know that thought that there was something in me worth finding out.
It's really busy out there.
I gotta get back to work.
Hey, Mark.
The thing is, I really miss her.
I'm sure you do.
I know it's hard, but as far as babies go, Little Susie's doing great.
Yeah.
I miss her too.
Jerry, put out a page on Steve Flint.
How's our score? Bleak, bleaker, bleakest.
No, wait.
We can mark this one off.
Omar Gandera.
Renal finally got here.
They're gonna take him upstairs.
- Did you call Psych for him? - They said to call back in a week.
Great.
Kid OD'd on antifreeze and Psych can't quite fit him in.
Exam 2's open.
Good work, Chuny.
- Somebody help me, please! - Park that guy.
Jerry, clear Trauma 2.
- What happened? - It's his chest! - What's your name? - Corky.
- Are you all right? - Yeah, but my dad is really sick.
Was he vomiting blood? It's on your shirt.
No, I just cut myself.
- What have we got? - A possible Ml.
- What's your father's name? - Louis Etheridge.
Louis? Louis? Mr.
Etheridge? - Is he on any medications? - I don't know.
Maybe.
- Air.
- Tachy at 120.
- BP, 160 palp.
- EKG, portable chest.
ABG, first-day CCU labs.
Fifteen liters of O-2, four of MS, titrate a nitroglycerine drip.
- O-2 sat's 100.
- Are you nauseous? Yes.
Please help me.
- Inferior Ml? - Has he had any heart trouble? No, that's not it.
What is it, Corky? It's okay to tell us.
Dr.
Greene? Why the hell did you pull me down here in the middle of the night? Wait outside, Dr.
Randall.
What's wrong with your father? - I need to talk to you.
- In a minute! - Corky? - I don't know.
He's just sick! Double lumen IVs.
Get a TPA tray.
Let me know when the 12-lead's done.
You got me out of bed at midnight for no reason.
- Your patient's just around the corner.
- I ordered her discharged hours ago.
She's had three TIAs in two days.
She needs to be admitted.
Stroke Council, AHA, Hospitalize for four or more TIAs in a two-week period.
Or for findings suggesting a worsening course.
I know it.
Her HMO will not authorize her admission.
She's one of your HMO patients.
They're the only ones who have patients anymore.
So we wait till she strokes out so they can keep their costs down? You don't have to wait for anything.
She is discharged.
That migraine in 4 is still complaining.
Try a milligram of DHE and 10 of Reglan.
- What's the story? - His father's an alcoholic.
His mother has been putting Antabuse in his father's coffee.
While he's still drinking? And not telling him? So he's still drinking and now he's having an Antabuse reaction.
That could have been fatal.
The kid knew all along? Hey, Corky! Mark, the kid's scared enough, okay? He should be.
His father could have died.
Call the mother and get her in here.
Excuse me, doctor.
My son's hand.
It really is a bad cut.
Your son has been triaged as a minor injury.
There are more urgent cases ahead of you.
You have to wait in the waiting room.
I asked you to keep these people out of here.
Now, I am running over to Doc's to pick up my sandwich, okay? I'll be back in two minutes.
Get this dead guy out of here.
Give me that! Call for help, okay? Hang on! I'm gonna get you out! Hang on! Hang on! Leita! If you just crawl out the window, we can get you out.
Anything? We're waiting for the other unit to show up with the equipment.
- Get the mother and daughter out.
- Her mother's unconscious.
Tell her to grab your hand.
You can pull her out.
I got it! I'll try to get in! - Come over to this side! - All right.
Hold it.
I can't reach her! Let me get in.
Grab my hand! Come on, grab my hand! - Grab my hand.
- Get out of there.
- I can grab ahold of her.
- Let me get in there.
- I almost got her hand.
- Doc, I can get her out of there, okay? Move! Let me get her out, okay? We'll bring her in.
Why don't you go dry off.
Get the Trauma rooms ready.
Jerry? - I wouldn't ask if I were you.
- Jerry.
Folding chairs for the waiting room.
They were ordered four hours ago.
Let me know when those accident victims get in.
I'm gonna go grab some coffee and dry scrubs.
And clear those Trauma rooms.
You don't have any coffee filters, do you? Are you kidding? No.
And we can't even do the folded paper towel trick.
Mr.
Carter, you are in luck.
Now, if we had a hair dryer, it'd really be our lucky day.
How do you do this? You gotta get the coffee grounds out without ripping the paper.
No, I mean this.
Patients stacked up everywhere and no end in sight.
It's like the O'Hare of emergency rooms.
It was a lot easier when I was younger.
I was newly married, I'd just had a baby.
Jennifer used to come in the middle of the night with chicken sandwiches.
She'd have Rachel in the car seat.
We'd picnic between the waiting-to-be-sutured and the bounced-back migraine.
- I guess it helped, having a family.
- Yeah.
Yeah, it did.
What are you gonna do? That is really bad.
I'm gonna go change.
That's a lovely little pup you got there, Mrs Excuse me, Ms.
Decksley.
Absolutely charming.
Hey, Stinky, want a few little stitches? - Shut that yappy little mouth of yours? - You're not a dog-lover, huh? This is not a dog, it's a small, furry object suitable for punting.
I bet you can't get him over that desk back there.
- Don't tempt me.
- But tempting is what I do for a living.
- I'm a lap dancer.
- Okay.
So I hooked up with this polyester guy tonight.
And I slipped right off his knee and bam! Sliced my butt on his spurs.
Why would you wear boots with polyester? I don't think I would.
Are you gonna stitch me up next? Because this cut really stings.
- You want something for the pain? - Drugs? Sure.
Any word from outside? They radioed over.
Probably be 10 minutes.
Jerry, call ICU.
This ventilator guy has been down here for days.
Do you want me to page Benton for that rule-out appy in 4? No, I'll check it out.
Lydia, get those labs on Cromley.
I thought you were trying to get that girl out.
I can't even get the lab to get a CBC in under three hours I can't get an x-ray in under two or any ICU beds to open up.
Mark, Jennifer's on the phone.
- Jen, what's up? - They brought Rachel home.
- She's not feeling well.
- It's 1 in the morning.
- They drove her back from the lake? - Her stomach hurts.
- Stomachache and what else? - She threw up.
Does she have a temperature? Maybe it's altitude sickness.
How do I know where the lake is? You didn't even tell me she was going.
Jen, I don't want to fight right now.
Listen, just put Rachel in bed.
Keep her on clear fluids and I'll call you in the morning.
What do you want me to do from down here? Well, I'm sorry you called too.
Jerry, get Carter in here.
- She'll be okay.
- Get this out of here.
- Do you want me to page Benton? - Yeah.
The ankle's deformed.
No cap refill or pulses.
BP's 80 palp.
Pulse, 110.
- Hey, doc, listen.
- Fracture dislocation.
We need to reduce.
Let's sedate her.
Prep 35 migs Ketamine, 0.
3 atropine.
- I was just trying to get her out of it.
- Start another line.
Half a gram of Ancef.
CBC, Chem-7, UA, portable chest and get an ankle.
We got her out, damn it.
Pulse, 140.
BP, 90/60.
Probable flail chest but good bilateral breath sounds.
Fractured left femur.
Abdomen's rigid, x-rays on the way.
- O-2 sat, 90.
- Blood ordered? Two units O-neg are up, type and crossed for eight.
Atropine, now.
Good work, Carter.
- Prep for a lavage.
You okay with that? - I'm okay with that, yeah.
Clear! Grab a C-spine and a post-intubation chest next door.
Ketamine's onboard.
She's out.
Wanna wait for the films? No, let's do it.
Countertraction.
- That's it.
Back in.
- She's coding! Where the hell's Benton? Page him, stat! All right, everybody off! - Okay, sinus brady.
- Mig of atropine.
- Mix up dopamine.
- I paged him 911.
Muffled heart sounds.
Neck vein distension.
And another pulse.
Thoracotomy tray.
Chuny, do compression.
- Tamponade? - Yeah.
It could be a cardiac laceration.
- Did you page him? - Twice.
- Rib spreader.
- O-neg.
Four more units.
Throw them on the infuser.
Sac's tense with blood.
Metz! - She's bleeding out.
- Rib punctured the heart.
Keep your finger over the hole and do compressions.
Should we wait for Benton? Let's try a 16 Foley, 30 cc balloon.
- Foley? - Clamp the end.
And saline, not air.
Last thing she needs is an air embolism.
- She's in fib.
- Internal paddles.
One second.
Carter, pay attention.
Catheter is going into the hole in the heart.
- Okay.
Now fill the balloon.
- Two units O-neg in.
Excellent.
Now, traction.
- What have we got? - Charging.
Charge 20.
Zapping.
- Sinus.
- Got a pulse.
Let's get her up to the O.
R.
Where have you been? We have a double trauma and you don't even respond? I was closing on a mesenteric infarction.
With how many Residents who could've? - It was my surgery.
I was busy.
- No, no, Peter.
Down here is busy.
In there is busy.
In there is where we ignore everything else.
I ignore my patients for in there.
I ignore my child, my marriage for in there.
Don't ever pull this again! Maybe the rain will keep the people home.
I thought it stopped raining.
Nope.
- Going - Going Gone.
- Is there a problem? -2:00.
- Bars are closing.
- They're getting in their cars.
- Going too fast.
- Swerving.
- Crashing.
- Paramedics are rolling out.
- Scooping them up.
- And dropping them off on our doorstep.
Dr.
Greene, that was a 911 call from our waiting room.
- It's a jungle out there.
- I know.
Drs.
Lewis, Ross, Weaver and Treloggen will be on in four hours and 58 minutes.
They will not be pleased.
By the way, Jerry, that light bulb's out.
- Did you discharge that ankle sprain? - About an hour ago.
- The rule-out Ml in 4? - Cardiology took him up.
- What about that kid with the cut hand? - With the mother? - Yeah.
- No, he's still in the Suture Room.
There's a metallic foreign body of 14 millimeters located one centimeter medial to the distal femoral condyle.
Morning, Harry.
- Labs back on that OD in 6.
- Excellent! Stick them on the chart.
Films are back on that busted collarbone.
Excellent.
Stick them on the chart.
- Mrs.
Huggins.
- This is my son, Danny.
- Hello, Danny.
- Hi.
- I need to see you a minute.
- Can't it wait? No, I don't think so.
Excuse me.
- Why Trauma 1? - She's not doing so well.
There are no exam rooms.
- Is her son with her? - Yeah.
Carol, why don't you take Corky outside.
- You drink coffee yet? - He's not supposed to, but he does.
Me too.
Come on, let's go get a cup.
I'm Dr.
Greene.
Corky didn't tell you about his father because I told him not to.
I told him not to tell anybody.
His condition tonight was very serious.
Antabuse is a deterrent to alcohol.
Mixing them can be fatal.
It's not that I want him to die.
It's just that when he drinks, it can get pretty bad.
There's blood on Corky's shirt.
Does your husband beat him as well? No.
Corky got in the middle.
I think it's from my nose.
There are places you can go, Mrs.
Etheridge.
Shelters where you and your son can be safe.
I know.
In cases of domestic violence I'm legally obligated to inform the police.
I know that too.
Jerry, call the police.
Domestic violence case.
Sure.
Carol, order a facial series and clean up the abrasions.
Okay.
Did he want to talk about it? Say anything? No.
Not a word.
Bend your finger.
- He was helping me hang a mirror.
- It weighed a ton.
Needless to say, we dropped it.
- Seven years of bad luck.
- I don't believe in that stuff.
It's fairly deep, but there's no tendon damage.
See? That's good luck.
- What time did it happen? - After dinner.
After Hard Copy, Mom.
- Unfortunately, I can't stitch it up.
- What? After six hours, the risk of infection is too high.
We've been here half the night and now you can't even do anything? I'll put him on antibiotics.
Come back in three days for a delayed closure.
Do we have to wait again? - Did they admit that bowel obstruction? - He's under the knife as we speak.
Good work.
Whoever's got gastrointestinal distress, rise and shine.
- Loretta.
- Hi, Dr.
Greene.
- These gurneys aren't bad.
- Are you all right? Yeah, I'm fine.
I mean, no.
You know, of course, I'm not.
It's Jimmy.
He's got a fever.
He's been throwing up.
- Come on, baby.
Wake up.
- Swing your feet over there.
- How are you doing there? - I puked twice in the waiting room.
He's kind of embarrassed.
There were six other men in line for the bathroom.
Yeah, it's a little crowded out there.
Sorry.
Your stomach feels okay? Open your mouth.
There you go.
Tongue out.
I don't think it's anything serious.
Your garden-variety 24-hour virus.
Nothing by mouth for six hours.
Then, sips of clear liquids.
If he keeps those down, you can try a little toast and applesauce for dinner.
- Thanks, Dr.
Greene.
- I'm sorry you had to wait so long.
It wasn't so bad.
We got in before a lot of the others did.
- You wanna help me grab some stuff? - Sure.
What do you need? Gauze, syringes, Ace wraps saline, suture sets, eye patches.
-4-0 nylon.
- Check.
- Skin staplers.
- Check.
- Tetanus boosters.
- Double check.
Haleh, Lydia, what are you doing for the next couple of hours? - He's kidding, right? - Can we treat them without a chart? - How's the hospital going to bill them? - Does that metal detector work? - You're not making an announcement? - And start a stampede? These are some of the more minor cases.
Explain to them what we are doing.
No labs or x-rays without a chart.
Richard Tomco? Anderson? Anderson? Mark, we know this guy.
What do you want this time, Ricky? Percocet? Demerol? No.
I'm telling you, this time it really hurts.
Yeah, it's abscessed.
Pretty nasty in there.
Five cc's Marcaine, 27-gauge needle.
Have any allergies? Open up.
You're gonna be numb for about six hours.
Dental clinic's on the second floor.
Opens at 9.
- Do I need stitches? - No.
When was your last tetanus shot? - Probably high school.
- Okay.
We'll give you one now.
But I want you to come back if there's any redness or swelling or red streaks, okay? Impetigo.
Write him for Keflex.
Uticaria, 0.
2 Susphrine sub-Q.
Subungual hematoma.
Drain it.
Do you think he's, you know, lost his grip on reality? No.
I think he's having fun.
Vaginal bleeding.
Haleh, do you think we can do a pelvic in the waiting room? Just kidding.
Take her back, spin a crit, dip a urine and do an ICON.
- Sudden-onset blindness.
- Woke up this morning couldn't see a thing.
Carter? Differential includes retinal detachment, central retinal artery occlusion, CVA.
Diabetic retinopathy, retinitis, macular degeneration.
She's too calm.
I think it's psychogenic.
Lydia, try and find that optokinetic drum.
If the eyes move when the drum spins, she's faking.
Molly and Sarah were roughhousing.
Don't buy bunk beds.
And Molly got pulled off the top.
Your arm hurts, Molly? Did you hit your head or anything else? - Want me to order an x-ray? - No, we don't need it.
Ms.
Taylor, one of the ligaments in Molly's elbow slipped out of place.
I'm gonna fix it.
She's gonna cry, but it'll only hurt for a second.
Jeffrey fed his brother a couple button batteries.
- You sure? - Yeah.
- I saw the second one go down myself.
- Why'd you do that? - Because he likes them.
- He likes them.
He's gonna need some x-rays.
If they're stuck in his esophagus, there's potential for a perforation.
Carter? Carter, hold on for a second.
Can I borrow this? Try that.
It's below the diaphragm.
No need to worry.
Check his stool.
They'll pass in a day or two.
That's great.
Thank you.
He's right.
Psychogenic.
Lois, I'll give you some eye drops.
I think they'll help your vision.
Just lean your head back.
Always give the patient a way out.
One more.
Okay.
That ought to do it.
Oh, yeah.
I can see everything.
It's still a little blurry, though.
By the time you get home, everything should be fine.
Mark, Mrs.
Lipshultz, And nauseous.
Sorry.
That's all right.
They're Doug's shoes.
Give her 10 of Compazine, I.
M.
What's bothering you, Mr.
Buchanan? Where does it hurt? Here.
How you doing, Mr.
Buchanan? My back is killing me.
- Not your shoulder? - No, no.
My back.
BP both arms.
Don't worry.
We're gonna take care of everything.
Where can I get one of these things? Her arm feels absolutely fine.
What do you say? - Thank you.
- You're very welcome.
We still have an eye pain, a neck pain, an abdominal pain - and a boil that needs to be lanced.
- Be there in a minute.
I know it's early, but I knew you'd be up.
How did you know? Because Bananas in Pajamas is on.
Don't turn it up, Rachel.
You'll wake up Mommy.
I'm glad you're feeling better, sweetie.
I'll see you next weekend.
- Love you.
- Love you too.
- Breakfast? - Thanks.
- Breakfast? - Thank you.
Be careful.
It's ugly out there.
Not as ugly as it's been in here.
Good night.
Good night.
What a night! You ever have to sleep in one of these things? I'll put your shoes by your locker.
Mine are probably dry by now.
- Thanks for the great work, Carol.
- That's why they pay me the big bucks.
Hey, Peter.
We're gonna have to find some way to work together.
Yeah, I guess we are.
How was dinner? - I fired him.
- What? I need a new lawyer.
The guy was a lightweight.
He said that Chloe could possibly have a case if in fact she does have a job What do you think? I've seen her go through hundreds of jobs.
What am I supposed to think? - Hey, Kerry.
- Hi, Mark.
I think I finally made sense of that QA review.
But you're on your way out.
We can go over it later.
Thank you.
I appreciate that.
Good night.
- I thought it would've stopped by now.
- Yeah.
Tonight was great.
The waiting room.
When I started med school, that's what I thought it would be like.
Really helping people.
At least, that's what I thought it was supposed to be.
That is what it's supposed to be.
- What are you gonna do today, Carter? - I don't know.
What are you gonna do? I don't know.
R.
Previously on E.
R.
- Is that alcohol on your breath? - Champagne.
It's grounds for expulsion.
It's none of your business.
We made a decision.
That's final.
No way.
No way! No! No! She's my baby, Susan, and I want her back.
I'm adopting her.
- The family had a right to know.
- You're right.
- You made a mistake.
- Why don't you just get out? Peter, Doug can handle this.
Go on.
Go on.
"A Shift In the Night" bringing you traffic and weather on the 1.
Rain all over Chicagoland today.
The rain continues to come down causing flooding on I-94 and other expressways.
The WMAQ weather calls for the rain to continue into tonight and it stays in our forecast through tomorrow.
Bring an umbrella, raincoat and life preserver- Son of a bitch.
Son of a bitch! Please leave a message at the tone.
Mark? Mark, if you 're there, it's Kerry Weaver.
Could you pick up? We got a little problem.
Neal Hansen's on tonight but his mother-in-law died, so The answer is no, Kerry.
I am not coming in.
I don't care if his mother-in-law died, okay? I've been on three nights in a row.
Tell Morgenstern that I can't and give the shift to Doug Ross.
He could use the money.
What do you mean, whiplash? No evidence of fracture or dislocation.
Vertebral bodies are in good alignment.
There is, however, reversal of cervical lordosis suggesting the possibility of acute cervical ligamentous injury.
My headache tripled during that dissertation.
Does the name Evelyn Wood mean anything to you? You know, Doug, I like you in that collar.
It's a good look.
Bold, yet spiritual.
No, I'm stopped dead at the stoplight and this Pakistani cabdriver plows into me.
I get out.
He doesn't speak a word of English.
I look at his photo ID and it's some sandy-haired guy named Kroopf.
Kroopf? Isn't that kind of a German name? - Can I have your shoes? - What? Can I have your shoes? Mine are sopping wet.
Sure, Mark, absolutely.
You know, I'll just walk home barefoot in the rain.
- Sorry.
I would've taken that shift- - No problem at all, Doug.
I've only worked graveyard the last three nights.
Got off at 8:00 this morning drove to Milwaukee to spend the day with Rachel only to have Jennifer tell me that she got the dates mixed up.
See, Rachel, it turns out, is on some Brownie troop camping trip.
So I drove back, three and a half hours this time because of the heavy rain and flooding on I-94.
And here I am, refreshed and full of enthusiasm for my work.
Are you on tonight? Go with God.
- Why are these patients in the hallway? - No beds.
- You're on tonight, right? - No, dinner with my lawyer at 7:00.
Dr.
Lewis, a Peter Kreidman called.
Can't make dinner till 7:30.
- Oh, 7:30.
- Can you change that to tomorrow night? Hansen's out, Doug has got whiplash Benton's in some marathon surgery and Kerry and I will be short-handed.
Mark, I'm sorry, I can't.
Chloe's gonna try and fight this adoption.
I can't miss this.
- Mark, I was afraid I'd miss you.
- You're leaving too? - I've been on 14 hours.
- I've been on the last three nights.
I'd stay, but Morgenstern wants me to present our QA at the JCAH in the morning.
Whoever handled it dropped the ball.
I'll be up all night pulling it together.
- It's a real mess.
- Yeah, I was handling it.
I'll walk you through it once I get it straightened out.
Shall we make rounds? Mr.
PCP is sleeping it off.
Probably needs another six hours.
Second-degree burns, both hands.
Checking pot roast, forgot hotpads.
Gangbanger in a fistfight.
- Fistfight? That's quaint.
- Waiting on x-rays.
hand and foot spasms.
CMV retinitis, PCP pneumonia, Gl lymphoma, waiting on ICU.
Rule-out Ml.
Waiting on Cardiology consult.
Calls himself Bobby Darin, claims he got a shark bite while in the pool at the Four Seasons Hotel.
Waiting on Psych.
Ten-centimeter laceration sustained while sliding into second.
Needs sutures.
Abdominal pain, probably food poisoning, but Surgery's ruling out an appy.
Severe shoulder pain and nosebleed.
Platelet count, 15,000.
Waiting on Hematology.
TPA patient on dopamine.
Pulmonary edema.
Intubated on a nitro drip.
Waiting on ICU.
Bicycle versus postal truck.
Multiple rib fractures bilateral hemopneumothoraces.
Critical but stable.
Let me guess.
ICU? Anaphylactic shock and septic shock.
I think that's about it.
How are things in Glocca Morra? Unbelievable.
It's been like this since the rain started.
- Who else is on besides me? - A few Residents, a Psych intern and maybe Carter.
Good night.
LOL with burned hands admitted to burn service films on that gang kid were negative, sent him home and the rule-out appy was ruled out and discharged.
Excellent, Haleh, you get three gold stars.
Carter? I have sutured the leg lac in 4, knee lac in 3, arm lac in 2 and head lac in 1.
That's it? All right.
We have seven waiting for ICU.
Make it eight.
Bounce-back hip replacement with DVT and PE.
We have 33 in the ER and 41 in the waiting room.
Make that 42.
Paramedics pulling in with an altered LOC.
Your mission, should you choose to accept it which you will, because you have no choice is to move these folks out so we can move these folks in.
I want quick turnover.
No big workups.
No unnecessary labs, x-rays or consults.
And no comments.
Carol, Carter, let's go meet the incoming.
Randi, I want a turkey sandwich from the cafeteria because Jerry isn't here yet.
Sorry, I'm late.
And I can't be responsible for him, Dr.
Greene.
Let me out of here! - Hi, Chuny.
You're late.
- I'm on at 8:00.
It's 8:04.
What have we got? Omar Gandera, 15.
Strolling down by The Loop, drunk out of his mind.
Vitals are stable.
BP, 120/80.
Fell on his knees.
He needs stitches.
- Are you guys having a party? - Don't start, Doris.
- How much did you drink, Omar? - Don't touch me! Get out of here! - Can I give Mrs.
Layton more Demerol? - How long has it been? - Three hours.
- All right, if you help with this kid.
All right.
On my count.
One, two, three.
- Put me down! - Buckle him up tight.
Party on.
- Let me out of here! - Sinus tach at 110.
- Carter, what do you want to do? - BP's still 120/80.
CBC, Chem-7, blood alcohol, tox screen ABG and saline.
Wide open.
- Carter, she said tie him tight.
- I did! - Labs are back on the kid with the fever.
- Any films? - Not yet.
- Go sit on Radiology and don't bug me until you've got everything.
- Carter, get the labs going.
I'll be back.
- Oh, yeah.
We're having some fun now.
There are non-displaced oblique fractures of the third and fourth metatarsal shafts with no significant angulation or comminution.
The foot's busted, okay? Splint him and ship him out.
- What are you doing? - Gonna fix his feet.
What did he do, stick them in a blender? No more mixed drinks.
Put him on the back burner.
We've got people who are a lot worse.
- Could you take a look at my mother? - In a minute.
What a mess, huh? It's not helped by the fact you were late.
- Are you the doctor in charge? - The one and only.
My son has a horrible cut on his hand.
- We'll get to him as soon as we can.
- I'll bring him in.
Jerry, can you take her to the waiting room? It's bleeding.
We've been waiting out there.
- Come on, ma'am.
- Jerry? Don't let people sneak in.
Whoever's out there has been triaged.
We'll see them as soon as we can.
No one gets in - unless they're dying.
- Right.
Malik? Mrs.
Votey, you're having weakness in your right arm? Yesterday and again today.
Everything's sort of out of focus.
- At one point she couldn't even speak.
- Scared my students half to death.
- My mother teaches self-defense.
- To seniors.
Squeeze.
Maybe I could just wait here for my regular doctor.
- Dr.
Randall.
Jack Randall.
- I know him.
Mrs.
Votey, you might be experiencing what we call TIAs transient ischemic attacks.
They can be a warning sign of impending stroke.
I'll call Dr.
Randall but in the meantime I'll admit you upstairs where they can work you up.
Start her on heparin, 800 an hour call Randall and get her admitted to Medicine.
- You want a CT first? - Let them do it.
We need the room.
I don't get it.
He's still altered - but his tox screen's negative.
- I have to pee.
- Ethanol? - None detected.
- PH? -7.
30.
- Omar, what did you drink? - I've got to pee.
Omar? - I gotta pee.
- Go ahead and pee.
There's a tube in your bladder.
Paramedics five minutes out.
Drive-by shooting.
- Who's on call for Trauma? - Shall I call Benton? - No.
Call Thoracic.
- Thoracic? You heard me.
Call Morgenstern, tell him we are closing the Trauma now.
- Lytes? - Not back yet.
- What's wrong with the lab tonight? - Same thing as us.
There's just too many patients.
Okay.
Say he has a gap.
Methanol, uremia, DKA.
Ethylene glycol? - You think he drank antifreeze? - Well, gotta rule it out.
Get a Wood's lamp.
- It's really jammed in there.
- What? I said, it's really jammed in there! - Carter, what are you doing? - Foreign body in the canal.
Have him lie down.
- Do you know what it is, sir? - What? A bead.
Carter, you having fun paying your penance in the ER? I'm off Surgical Service I'm working nights in the ER.
What's not to be happy about? It's better than not graduating.
I thought Dr.
Hicks might suspend me.
She would if she could have.
I can't believe I was that stupid, drinking on call.
I can.
You're a medical student.
Superglue? Yes.
Just touch the bead.
Hit the skin, you're in trouble.
- Don't move! - Don't move! Dr.
Greene, the paramedics are here.
Got it! - How old is she? -18 months.
Two gunshots to the right upper leg.
Hypotensive.
Can't get a line.
It's okay, baby.
We're here.
Cops got the boy who did it.
Black kid, 14 years old.
Shot him dead.
Can't say I'm sorry.
- Cops never mind shooting a black kid.
- And he didn't mind shooting this one.
CBC, type and cross for two.
Get a unit of O-neg.
Right foot's cold.
No pulse.
- Femoral artery.
- I'll call for x-rays.
Sixteen-gauge Jamshidi.
One percent with epi.
Faint pulse.
Dynamap's not reading.
One-twenty of saline.
Fill these tubes.
Haleh, page Netzley.
- Malik, you're gonna take her up to O.
R.
- You got it.
Dr.
Greene, about closing Trauma, Morgenstern gave the big "N-O.
" - Get him on the phone for me.
- He went back up to Surgery.
- All right, I'll find him.
- Mark, bingo on Omar.
You got it? I want Daddy! - Ethylene glycol it is.
- What's that? Antifreeze.
Get Renal down here stat.
- Let's give him IV ethanol.
- We don't have any.
What? I checked.
Pharmacy's out.
St.
Luke's is sending us some, but it won't be here for another hour.
There's a bottle of bourbon out in that shopping cart in the hall.
- Bourbon? -120 cc oral loading dose.
Thirty cc's POQ one hour.
Otherwise, he's got brain damage and renal failure.
Bourbon shooters it is.
Labs are finally back on that coma in 2.
It's DKA.
Start an insulin drip, - Mrs.
Votey had another TIA.
- She's supposed to be at Medicine.
- Dr.
Randall said to discharge her.
- Discharge her? Is he nuts? Page him 911 and tell him to get in here now.
Here you go- Who let this dog in here? Try taking it away and it bites you.
- That puker in 4 is still at it.
-10 of Compazine and a liter of saline.
- Mr.
Nathan in 5, he's- - Morgenstern is up at the front.
What about the turkey sandwich? - I can get it almost immediately.
- Who are we talking about? Mr.
Nathan in 5, high white count temp's 101, has left lower-quadrant pain.
Probably diverticulitis.
Give him amp, gent, Flagyl and get an abdominal series.
That's right.
Bring him in.
- Answering the phones? - I'm here to help.
Then why don't you close up the Trauma? Sorry, Mark.
County's looking for excuses to put us out of business.
Well, it's 10:30.
We've got enough business to last a year.
-32 in the ER, 49 in the waiting room.
- Look, Mark, I'm sorry.
Got a little Benton fracas in Trauma 2.
Board of Commissioners wants to close an ER and save $80 million a year.
Every time we close, we're saying that we're not capable of providing.
Well, we're not.
I now have nine ICU patients draining my staff we've no monitored beds.
Here are the films on Robinson.
I can't even help half the patients here.
It's insane.
I talked to the critical care coordinators.
We move six patients from ICU to Telemetry, but we're staying open.
So what? He's oxygenating well.
The tube heads medially, striking the mediastinum.
Peter, Shelly.
- Why didn't you page me? - Shelly's handling it.
- I'm on call for Trauma.
- We didn't need you.
- If you don't want help during- - Gentlemen, please.
Ladies! I don't hear anybody helping here.
What's going on? Third-year Surgical Resident Leung placed the chest tube anteriorly.
- Which has relieved the pneumothorax.
- But will not drain the hemothorax.
Which can be repositioned when we prep.
Excellent idea! Let's all scrub in.
Come on, folks.
Let's go.
- If you need anything, give me a call.
- How about a turkey sandwich? Too late.
Cafeteria closes at 10 now.
County cutbacks.
It's a piece of cartilage that doesn't turn to bone until you're grown-up.
- Dr.
Greene.
- Carter.
Chloe.
Hi, Mark.
I came here to see Susie, but John says she's not on tonight.
No, she isn't.
Chloe was curious about how to read an x-ray.
I guess the interest in medicine must run in the family.
Yeah, right.
Junior gymnast in 5.
Fractured patella.
Time to break the bad news.
That hand is so little.
- Look at that.
- It's probably 4 or 5 years old.
Little Susie's hand is about that big, right? So Susie probably told you what's going on with us.
Yeah, she mentioned some things.
I understand why she's upset with me.
I never thought I could change, why should she? I just want her to see that things are different now, that I'm different now.
- Did she tell you that I'm engaged? - No, she didn't.
He's a great guy.
Steady.
He's as smart as Susie is.
He's the only person, besides Susie, who's ever taken the time with me to get to know me, you know that thought that there was something in me worth finding out.
It's really busy out there.
I gotta get back to work.
Hey, Mark.
The thing is, I really miss her.
I'm sure you do.
I know it's hard, but as far as babies go, Little Susie's doing great.
Yeah.
I miss her too.
Jerry, put out a page on Steve Flint.
How's our score? Bleak, bleaker, bleakest.
No, wait.
We can mark this one off.
Omar Gandera.
Renal finally got here.
They're gonna take him upstairs.
- Did you call Psych for him? - They said to call back in a week.
Great.
Kid OD'd on antifreeze and Psych can't quite fit him in.
Exam 2's open.
Good work, Chuny.
- Somebody help me, please! - Park that guy.
Jerry, clear Trauma 2.
- What happened? - It's his chest! - What's your name? - Corky.
- Are you all right? - Yeah, but my dad is really sick.
Was he vomiting blood? It's on your shirt.
No, I just cut myself.
- What have we got? - A possible Ml.
- What's your father's name? - Louis Etheridge.
Louis? Louis? Mr.
Etheridge? - Is he on any medications? - I don't know.
Maybe.
- Air.
- Tachy at 120.
- BP, 160 palp.
- EKG, portable chest.
ABG, first-day CCU labs.
Fifteen liters of O-2, four of MS, titrate a nitroglycerine drip.
- O-2 sat's 100.
- Are you nauseous? Yes.
Please help me.
- Inferior Ml? - Has he had any heart trouble? No, that's not it.
What is it, Corky? It's okay to tell us.
Dr.
Greene? Why the hell did you pull me down here in the middle of the night? Wait outside, Dr.
Randall.
What's wrong with your father? - I need to talk to you.
- In a minute! - Corky? - I don't know.
He's just sick! Double lumen IVs.
Get a TPA tray.
Let me know when the 12-lead's done.
You got me out of bed at midnight for no reason.
- Your patient's just around the corner.
- I ordered her discharged hours ago.
She's had three TIAs in two days.
She needs to be admitted.
Stroke Council, AHA, Hospitalize for four or more TIAs in a two-week period.
Or for findings suggesting a worsening course.
I know it.
Her HMO will not authorize her admission.
She's one of your HMO patients.
They're the only ones who have patients anymore.
So we wait till she strokes out so they can keep their costs down? You don't have to wait for anything.
She is discharged.
That migraine in 4 is still complaining.
Try a milligram of DHE and 10 of Reglan.
- What's the story? - His father's an alcoholic.
His mother has been putting Antabuse in his father's coffee.
While he's still drinking? And not telling him? So he's still drinking and now he's having an Antabuse reaction.
That could have been fatal.
The kid knew all along? Hey, Corky! Mark, the kid's scared enough, okay? He should be.
His father could have died.
Call the mother and get her in here.
Excuse me, doctor.
My son's hand.
It really is a bad cut.
Your son has been triaged as a minor injury.
There are more urgent cases ahead of you.
You have to wait in the waiting room.
I asked you to keep these people out of here.
Now, I am running over to Doc's to pick up my sandwich, okay? I'll be back in two minutes.
Get this dead guy out of here.
Give me that! Call for help, okay? Hang on! I'm gonna get you out! Hang on! Hang on! Leita! If you just crawl out the window, we can get you out.
Anything? We're waiting for the other unit to show up with the equipment.
- Get the mother and daughter out.
- Her mother's unconscious.
Tell her to grab your hand.
You can pull her out.
I got it! I'll try to get in! - Come over to this side! - All right.
Hold it.
I can't reach her! Let me get in.
Grab my hand! Come on, grab my hand! - Grab my hand.
- Get out of there.
- I can grab ahold of her.
- Let me get in there.
- I almost got her hand.
- Doc, I can get her out of there, okay? Move! Let me get her out, okay? We'll bring her in.
Why don't you go dry off.
Get the Trauma rooms ready.
Jerry? - I wouldn't ask if I were you.
- Jerry.
Folding chairs for the waiting room.
They were ordered four hours ago.
Let me know when those accident victims get in.
I'm gonna go grab some coffee and dry scrubs.
And clear those Trauma rooms.
You don't have any coffee filters, do you? Are you kidding? No.
And we can't even do the folded paper towel trick.
Mr.
Carter, you are in luck.
Now, if we had a hair dryer, it'd really be our lucky day.
How do you do this? You gotta get the coffee grounds out without ripping the paper.
No, I mean this.
Patients stacked up everywhere and no end in sight.
It's like the O'Hare of emergency rooms.
It was a lot easier when I was younger.
I was newly married, I'd just had a baby.
Jennifer used to come in the middle of the night with chicken sandwiches.
She'd have Rachel in the car seat.
We'd picnic between the waiting-to-be-sutured and the bounced-back migraine.
- I guess it helped, having a family.
- Yeah.
Yeah, it did.
What are you gonna do? That is really bad.
I'm gonna go change.
That's a lovely little pup you got there, Mrs Excuse me, Ms.
Decksley.
Absolutely charming.
Hey, Stinky, want a few little stitches? - Shut that yappy little mouth of yours? - You're not a dog-lover, huh? This is not a dog, it's a small, furry object suitable for punting.
I bet you can't get him over that desk back there.
- Don't tempt me.
- But tempting is what I do for a living.
- I'm a lap dancer.
- Okay.
So I hooked up with this polyester guy tonight.
And I slipped right off his knee and bam! Sliced my butt on his spurs.
Why would you wear boots with polyester? I don't think I would.
Are you gonna stitch me up next? Because this cut really stings.
- You want something for the pain? - Drugs? Sure.
Any word from outside? They radioed over.
Probably be 10 minutes.
Jerry, call ICU.
This ventilator guy has been down here for days.
Do you want me to page Benton for that rule-out appy in 4? No, I'll check it out.
Lydia, get those labs on Cromley.
I thought you were trying to get that girl out.
I can't even get the lab to get a CBC in under three hours I can't get an x-ray in under two or any ICU beds to open up.
Mark, Jennifer's on the phone.
- Jen, what's up? - They brought Rachel home.
- She's not feeling well.
- It's 1 in the morning.
- They drove her back from the lake? - Her stomach hurts.
- Stomachache and what else? - She threw up.
Does she have a temperature? Maybe it's altitude sickness.
How do I know where the lake is? You didn't even tell me she was going.
Jen, I don't want to fight right now.
Listen, just put Rachel in bed.
Keep her on clear fluids and I'll call you in the morning.
What do you want me to do from down here? Well, I'm sorry you called too.
Jerry, get Carter in here.
- She'll be okay.
- Get this out of here.
- Do you want me to page Benton? - Yeah.
The ankle's deformed.
No cap refill or pulses.
BP's 80 palp.
Pulse, 110.
- Hey, doc, listen.
- Fracture dislocation.
We need to reduce.
Let's sedate her.
Prep 35 migs Ketamine, 0.
3 atropine.
- I was just trying to get her out of it.
- Start another line.
Half a gram of Ancef.
CBC, Chem-7, UA, portable chest and get an ankle.
We got her out, damn it.
Pulse, 140.
BP, 90/60.
Probable flail chest but good bilateral breath sounds.
Fractured left femur.
Abdomen's rigid, x-rays on the way.
- O-2 sat, 90.
- Blood ordered? Two units O-neg are up, type and crossed for eight.
Atropine, now.
Good work, Carter.
- Prep for a lavage.
You okay with that? - I'm okay with that, yeah.
Clear! Grab a C-spine and a post-intubation chest next door.
Ketamine's onboard.
She's out.
Wanna wait for the films? No, let's do it.
Countertraction.
- That's it.
Back in.
- She's coding! Where the hell's Benton? Page him, stat! All right, everybody off! - Okay, sinus brady.
- Mig of atropine.
- Mix up dopamine.
- I paged him 911.
Muffled heart sounds.
Neck vein distension.
And another pulse.
Thoracotomy tray.
Chuny, do compression.
- Tamponade? - Yeah.
It could be a cardiac laceration.
- Did you page him? - Twice.
- Rib spreader.
- O-neg.
Four more units.
Throw them on the infuser.
Sac's tense with blood.
Metz! - She's bleeding out.
- Rib punctured the heart.
Keep your finger over the hole and do compressions.
Should we wait for Benton? Let's try a 16 Foley, 30 cc balloon.
- Foley? - Clamp the end.
And saline, not air.
Last thing she needs is an air embolism.
- She's in fib.
- Internal paddles.
One second.
Carter, pay attention.
Catheter is going into the hole in the heart.
- Okay.
Now fill the balloon.
- Two units O-neg in.
Excellent.
Now, traction.
- What have we got? - Charging.
Charge 20.
Zapping.
- Sinus.
- Got a pulse.
Let's get her up to the O.
R.
Where have you been? We have a double trauma and you don't even respond? I was closing on a mesenteric infarction.
With how many Residents who could've? - It was my surgery.
I was busy.
- No, no, Peter.
Down here is busy.
In there is busy.
In there is where we ignore everything else.
I ignore my patients for in there.
I ignore my child, my marriage for in there.
Don't ever pull this again! Maybe the rain will keep the people home.
I thought it stopped raining.
Nope.
- Going - Going Gone.
- Is there a problem? -2:00.
- Bars are closing.
- They're getting in their cars.
- Going too fast.
- Swerving.
- Crashing.
- Paramedics are rolling out.
- Scooping them up.
- And dropping them off on our doorstep.
Dr.
Greene, that was a 911 call from our waiting room.
- It's a jungle out there.
- I know.
Drs.
Lewis, Ross, Weaver and Treloggen will be on in four hours and 58 minutes.
They will not be pleased.
By the way, Jerry, that light bulb's out.
- Did you discharge that ankle sprain? - About an hour ago.
- The rule-out Ml in 4? - Cardiology took him up.
- What about that kid with the cut hand? - With the mother? - Yeah.
- No, he's still in the Suture Room.
There's a metallic foreign body of 14 millimeters located one centimeter medial to the distal femoral condyle.
Morning, Harry.
- Labs back on that OD in 6.
- Excellent! Stick them on the chart.
Films are back on that busted collarbone.
Excellent.
Stick them on the chart.
- Mrs.
Huggins.
- This is my son, Danny.
- Hello, Danny.
- Hi.
- I need to see you a minute.
- Can't it wait? No, I don't think so.
Excuse me.
- Why Trauma 1? - She's not doing so well.
There are no exam rooms.
- Is her son with her? - Yeah.
Carol, why don't you take Corky outside.
- You drink coffee yet? - He's not supposed to, but he does.
Me too.
Come on, let's go get a cup.
I'm Dr.
Greene.
Corky didn't tell you about his father because I told him not to.
I told him not to tell anybody.
His condition tonight was very serious.
Antabuse is a deterrent to alcohol.
Mixing them can be fatal.
It's not that I want him to die.
It's just that when he drinks, it can get pretty bad.
There's blood on Corky's shirt.
Does your husband beat him as well? No.
Corky got in the middle.
I think it's from my nose.
There are places you can go, Mrs.
Etheridge.
Shelters where you and your son can be safe.
I know.
In cases of domestic violence I'm legally obligated to inform the police.
I know that too.
Jerry, call the police.
Domestic violence case.
Sure.
Carol, order a facial series and clean up the abrasions.
Okay.
Did he want to talk about it? Say anything? No.
Not a word.
Bend your finger.
- He was helping me hang a mirror.
- It weighed a ton.
Needless to say, we dropped it.
- Seven years of bad luck.
- I don't believe in that stuff.
It's fairly deep, but there's no tendon damage.
See? That's good luck.
- What time did it happen? - After dinner.
After Hard Copy, Mom.
- Unfortunately, I can't stitch it up.
- What? After six hours, the risk of infection is too high.
We've been here half the night and now you can't even do anything? I'll put him on antibiotics.
Come back in three days for a delayed closure.
Do we have to wait again? - Did they admit that bowel obstruction? - He's under the knife as we speak.
Good work.
Whoever's got gastrointestinal distress, rise and shine.
- Loretta.
- Hi, Dr.
Greene.
- These gurneys aren't bad.
- Are you all right? Yeah, I'm fine.
I mean, no.
You know, of course, I'm not.
It's Jimmy.
He's got a fever.
He's been throwing up.
- Come on, baby.
Wake up.
- Swing your feet over there.
- How are you doing there? - I puked twice in the waiting room.
He's kind of embarrassed.
There were six other men in line for the bathroom.
Yeah, it's a little crowded out there.
Sorry.
Your stomach feels okay? Open your mouth.
There you go.
Tongue out.
I don't think it's anything serious.
Your garden-variety 24-hour virus.
Nothing by mouth for six hours.
Then, sips of clear liquids.
If he keeps those down, you can try a little toast and applesauce for dinner.
- Thanks, Dr.
Greene.
- I'm sorry you had to wait so long.
It wasn't so bad.
We got in before a lot of the others did.
- You wanna help me grab some stuff? - Sure.
What do you need? Gauze, syringes, Ace wraps saline, suture sets, eye patches.
-4-0 nylon.
- Check.
- Skin staplers.
- Check.
- Tetanus boosters.
- Double check.
Haleh, Lydia, what are you doing for the next couple of hours? - He's kidding, right? - Can we treat them without a chart? - How's the hospital going to bill them? - Does that metal detector work? - You're not making an announcement? - And start a stampede? These are some of the more minor cases.
Explain to them what we are doing.
No labs or x-rays without a chart.
Richard Tomco? Anderson? Anderson? Mark, we know this guy.
What do you want this time, Ricky? Percocet? Demerol? No.
I'm telling you, this time it really hurts.
Yeah, it's abscessed.
Pretty nasty in there.
Five cc's Marcaine, 27-gauge needle.
Have any allergies? Open up.
You're gonna be numb for about six hours.
Dental clinic's on the second floor.
Opens at 9.
- Do I need stitches? - No.
When was your last tetanus shot? - Probably high school.
- Okay.
We'll give you one now.
But I want you to come back if there's any redness or swelling or red streaks, okay? Impetigo.
Write him for Keflex.
Uticaria, 0.
2 Susphrine sub-Q.
Subungual hematoma.
Drain it.
Do you think he's, you know, lost his grip on reality? No.
I think he's having fun.
Vaginal bleeding.
Haleh, do you think we can do a pelvic in the waiting room? Just kidding.
Take her back, spin a crit, dip a urine and do an ICON.
- Sudden-onset blindness.
- Woke up this morning couldn't see a thing.
Carter? Differential includes retinal detachment, central retinal artery occlusion, CVA.
Diabetic retinopathy, retinitis, macular degeneration.
She's too calm.
I think it's psychogenic.
Lydia, try and find that optokinetic drum.
If the eyes move when the drum spins, she's faking.
Molly and Sarah were roughhousing.
Don't buy bunk beds.
And Molly got pulled off the top.
Your arm hurts, Molly? Did you hit your head or anything else? - Want me to order an x-ray? - No, we don't need it.
Ms.
Taylor, one of the ligaments in Molly's elbow slipped out of place.
I'm gonna fix it.
She's gonna cry, but it'll only hurt for a second.
Jeffrey fed his brother a couple button batteries.
- You sure? - Yeah.
- I saw the second one go down myself.
- Why'd you do that? - Because he likes them.
- He likes them.
He's gonna need some x-rays.
If they're stuck in his esophagus, there's potential for a perforation.
Carter? Carter, hold on for a second.
Can I borrow this? Try that.
It's below the diaphragm.
No need to worry.
Check his stool.
They'll pass in a day or two.
That's great.
Thank you.
He's right.
Psychogenic.
Lois, I'll give you some eye drops.
I think they'll help your vision.
Just lean your head back.
Always give the patient a way out.
One more.
Okay.
That ought to do it.
Oh, yeah.
I can see everything.
It's still a little blurry, though.
By the time you get home, everything should be fine.
Mark, Mrs.
Lipshultz, And nauseous.
Sorry.
That's all right.
They're Doug's shoes.
Give her 10 of Compazine, I.
M.
What's bothering you, Mr.
Buchanan? Where does it hurt? Here.
How you doing, Mr.
Buchanan? My back is killing me.
- Not your shoulder? - No, no.
My back.
BP both arms.
Don't worry.
We're gonna take care of everything.
Where can I get one of these things? Her arm feels absolutely fine.
What do you say? - Thank you.
- You're very welcome.
We still have an eye pain, a neck pain, an abdominal pain - and a boil that needs to be lanced.
- Be there in a minute.
I know it's early, but I knew you'd be up.
How did you know? Because Bananas in Pajamas is on.
Don't turn it up, Rachel.
You'll wake up Mommy.
I'm glad you're feeling better, sweetie.
I'll see you next weekend.
- Love you.
- Love you too.
- Breakfast? - Thanks.
- Breakfast? - Thank you.
Be careful.
It's ugly out there.
Not as ugly as it's been in here.
Good night.
Good night.
What a night! You ever have to sleep in one of these things? I'll put your shoes by your locker.
Mine are probably dry by now.
- Thanks for the great work, Carol.
- That's why they pay me the big bucks.
Hey, Peter.
We're gonna have to find some way to work together.
Yeah, I guess we are.
How was dinner? - I fired him.
- What? I need a new lawyer.
The guy was a lightweight.
He said that Chloe could possibly have a case if in fact she does have a job What do you think? I've seen her go through hundreds of jobs.
What am I supposed to think? - Hey, Kerry.
- Hi, Mark.
I think I finally made sense of that QA review.
But you're on your way out.
We can go over it later.
Thank you.
I appreciate that.
Good night.
- I thought it would've stopped by now.
- Yeah.
Tonight was great.
The waiting room.
When I started med school, that's what I thought it would be like.
Really helping people.
At least, that's what I thought it was supposed to be.
That is what it's supposed to be.
- What are you gonna do today, Carter? - I don't know.
What are you gonna do? I don't know.