ER s03e21 Episode Script
Make a Wish
Previously on ER Rejoice, lost man! Chaos is your destiny! You scare this baby, he won't come out.
Two of the best transplant surgeons let us look over their shoulders, and you just leave? Is that a problem? - Okay, I'll stay on the couch.
- Me too.
- I'm looking for a head doctor.
- Which one? Bald white guy, little glasses? Great! Just walk away! Is Dr.
Benton done with that thyroidectomy? So he's still in there? - Dr.
Benton.
- Carter, what are you doing here? Let's get an ABG in 20 minutes.
I thought you were covering the ER.
I'm on in a few.
We need to talk.
Make it fast.
I've got two admissions, a clinic and an aneurysm.
I've been thinking about that kidney case when I left to check on the patients during the debriefing.
Instead of listening to two of the finest surgeons in the country? I guess so.
And I've just been wondering.
Maybe I'm in the wrong place.
If you're still here in two minutes, you are.
I mean surgery.
Obviously, I love it, and I feel challenged by it.
But are you ever not quite satisfied? Carter, sometimes the patient dies.
- I know.
But otherwise.
- Otherwise what? Well, it just feels like sometimes they exist for us to do procedures.
That's why they're here.
We don't need to know anything about them? Like how worried they are or where they went to high school or whether they like cats or dogs? What are you talking about? I like to know the other stuff.
What for? I mean, if you Damn! Listen, we'll talk later.
It was at least 50 questions about my family background.
Nothing like the head of Security to make you feel insecure.
He almost withheld my ID because I didn't know my stepmom's maiden name.
He didn't cut you slack on that picture either.
You'd think I was trying to enter the White House.
Which is easier.
I've done it.
- Can you get these over to Radiology? - Now? Unless you're doing something urgent that I can't quite see.
Go.
Dr.
Ross, Pedes called.
You're covering deliveries for John Lavagnino.
Broken kneecap.
All right.
Good morning to you.
Not for Anna.
She just had her security clearance interview.
Did you get strip-searched? Checked for track marks? Practically.
They're cracking down because of what happened to Mark.
- He starts back today? - I wish he'd take another week.
Let's make sure we keep his load light for the first few days.
I want him helping me plan Carol's surprise birthday party.
- Doug! - Happy birthday, Carol.
I got vomiting and diarrhea in 4.
Happy birthday.
And I'm taking the quadruple bounce-back migraine in 5.
Nothing like a little drug-seeking behavior to start your day.
You promised you wouldn't tell anybody about my birthday.
- That was last year.
- You told everybody then too.
At least I'm consistent.
All right, coffee can wait.
What's this? It's a coffeepot.
That is not a coffeepot.
- It's called a French press.
- No more aluminum percolator? We're gonna have great coffee.
Which can wait.
- What's that? - The microwave.
- I'm heating up some cinnamon buns.
- The microwave.
- I always wanted a microwave.
- I know.
You wouldn't let me get one.
You said it broke down the vitamins.
I know.
I'm sorry.
I was wrong.
Come back over here.
This is nice.
I mean, this is really nice.
- What happened? - It's getting close, 9 centimeters.
- I'm all right.
- She failed tocolysis.
Her contractions are strong.
They went from 4 to 9 in no time.
Why didn't you call me? Last time they gave me that stuff, and it was fine.
- Couldn't you have done something else? - This baby's coming.
It's coming? Two months early? - I know that.
- You should've called me.
I just did, hoping you'd want to participate in the birth.
If that's what you'd like to do, I suggest you gown up.
- Dr.
Greene, right? How are you? - I'm fine, thank you.
Who are you? Anna Del Amico.
We met last week.
We didn't actually meet.
I was there when you were attacked.
- In the men's room? - In the Trauma Room afterwards.
I don't remember either room, so I don't remember you either.
I start my Emergency Residency in July.
I'm doing ER Pedes until then.
That was my first day.
I'm sorry it had to be so exciting.
I'm just glad you're okay.
So welcome back.
Thank you.
Where is everybody? - What you doing here? - Getting back to work.
Doug and Carol are bringing in an MVA.
- Hey, how are you doing? - Welcome back.
Nice to be back.
What do we got? - Bicycle versus tour bus.
- Don't worry.
We got it.
Just take it easy.
Settle in.
Nice and easy.
Here we go! Dr.
Greene! You look great.
OB needs you for that delivery.
Find Dr.
Del Amico.
See if she can take it.
I'll talk to you later.
- She's at the desk.
- Who? - Dr.
Del Amico.
She's at the desk.
- Oh, right.
Thanks.
- Help me shift her down.
- Breathe, Carla.
Come on, baby.
You can do it.
- How much mag you give her? - Six grams.
I gave three an hour until she hit 4 centimeters.
Dorgan, scalp electrode.
Keep breathing.
You're doing great.
Dorgan? What kind of name is that? Irish, through and through.
We've experience having a lot of babies.
Is she at risk for chorioamnionitis? Come on, breathe! Don't yell at me, damn it! - You give her antenatal steroids? - Twelve milligrams betamethasone.
And her blood sugar? She's got gestational diabetes.
You're doing great.
Hang in there.
Not much longer.
You'll be able to push soon.
What about a second dose? This baby's gonna have RDS! What is RDS? It's okay.
It just means the baby's lungs haven't matured yet.
- What? - It's okay.
Hold her hand! Help her breathe! Help her focus! That's your only job here.
Get over there and help the mother of your child.
There'll be two additional security cameras here.
- And two at the employees' entrance.
- Right.
The ambulance-bay doors will be changed to bulletproof glass which we'll also add to Triage.
The hospital agreed to additional armed security in your waiting room.
And the bathrooms? Any cameras in there? Unfortunately, privacy issues won't allow us to do that.
My assailant's privacy would've definitely been violated.
We can only do what we can do.
Thank you, Mr.
Biggers.
It's nice to see you, but what are you doing here? Working.
It's nice to see you too, Chuny.
These additional security measures may not help, but they can't hurt.
Everyone's overreacting.
What we should change is the way we deal with patients and their families.
- They're a pain in the ass.
- Your compassion knows no bounds.
Detective Warrington called.
Can't make it by till later this afternoon.
You think a patient or family member did this? I think that gives them a good reason.
Look.
Louise Pierson.
Ankle x-ray.
Three hours ago.
Where is it? Discharge orders written almost 2 hours ago.
Chart's still here, so the guy's still here.
Come on! Med-Surg admission, Neuro consult, ETA 7:15 this morning.
Where are they? We keep these people hanging around.
I'd get pissed off enough to clobber somebody.
Before Records clobbers me, I need you to sign off these charts.
I got them.
I'm fine.
- Push! You're almost there! - Come on.
Keep going.
- I'm Del Amico from Pedes.
- Janet Coburn.
- I thought Ross was covering.
- He's got a teenager MVA.
This is Carla Reece: Mother.
Peter Benton: Father.
Hi.
Just keep pushing so I can take a look at your baby.
- Mr.
Benton, how are you doing? - It's Dr.
Benton, Surgical Resident.
- You're new here? - Yes, from Children's in Philadelphia.
- Are you a Resident? - Correct.
How many deliveries did you attend over there? I stopped counting around 200.
We've got a late decel here.
- Carla's at 32 weeks.
- Any meconium? - Fluid's clear.
- Heart rate's dropping.
- Where's the NICU nurse? - On her way.
- Down to 120.
- Why isn't he coming? - He's coming, baby.
- Let's get this baby out of here.
- I need vacuum extraction.
- Why vacuum extraction? - We're at 100 here.
- That's why.
- Number for Respiratory Therapy? - Three-three-nine-four.
I brought some stuff in today because I knew you'd be starting back.
What are you doing? I know you'll be a little resistant to this but you'll feel safer if you carry something on you.
What is this stuff? I've got cops in my family, so I can get anything.
Electronic stun gun, personal taser.
- I don't think so.
- At least take the pepper spray.
I appreciate it, really, but it's not for me.
I'm not suggesting you pack a gun, although that's what I do.
- You carry a gun? - Under the front seat of my car.
I was at the drive-in once, waiting for fries and this punk sticks a knife in my face.
He wants my wallet.
So I reach under the seat, grab the.
357 stick it up his nose, and could that kid run! - Dr.
Greene, welcome back.
- Thanks.
Listen, thanks, Maggie, but I'll pass on the armaments.
Are you in the ER all day? Because I'll need your help.
I don't have full mobility yet for procedures.
- What is all this stuff? - I was trying to get Dr.
Greene to - Oh, my God! - Sit down! Oh, my God! Maggie, help me! Just sit! Just sit! I'll get a nurse! I'll be right back.
Don't move.
Don't touch your eyes.
That's it.
Push! Push! - Come on.
Breathe.
- We got him! It's okay, baby.
It's okay.
Blue and floppy.
Ready the liter.
What is it? I can't hear him.
- What's going on? What's wrong? - DeLee suction.
- Please tell me what's going on.
- I don't like his color.
Come on, little guy.
Pick up for us.
Let's go.
- What's the Apgar? - Zero for color.
Peter, back off! Let her work! Muscle tone, zero.
One for reflex.
Two for heart rate.
One-minute Apgar, 4 out of 10.
You gotta do something! Let's go! Tell me what's going on.
It's okay, baby.
It's okay.
They got him.
- He's got retractions.
- I need to tube him.
Two-point-five.
Heart rate down.
Eighty-five.
Start compressions.
Draw.
02 epi.
Call the NICU.
Tell them we're on the way.
I'm sorry.
- I know it's not funny, but - No, it's funny.
My whole life is just one big funfest.
Anspaugh hates me, Benton looks at me like I'm some kind of an alien.
Those things are in your favor.
Right.
Thank you.
When you were thinking about med school you were willing to start over? All that work? As opposed to the 6 more years of Surgical Residency ahead of you? I see your point.
- You back among the living? - Absolutely.
We've got an MVA coming in six or seven minutes.
It's not my place to say, but he looks kind of bad.
You okay there? I'm just going to get everything ready for you.
Be right back.
Just hang in there.
You're almost there.
What are we gonna do? Have you seen him? I'll check on him as soon as you're settled.
Just take it easy.
Just be a couple of more minutes.
Housekeeping hasn't finished.
One, two, three.
Rib? - We'll kick you out.
- I'm fine.
Normal vital signs.
Oxygen, 5 liters.
GCS, 11.
Mind if I steal some saline? Help yourself.
Pupils are equal and reactive.
No hemotympanum.
Chest is clear.
Abdomen soft and flat.
Pulse is 80.
BP, 120 over 75.
- What's his name? - Harry Smith.
Harry, can you hear me? Do you know where you are? - Let's order something.
- CBC, Chem-7, type and screen.
- You want to dip a urine? - Get a C-spine, chest and pelvis.
Police said it was a DUI? He was swerving on the Eisenhower, going 35.
He hit a light pole.
- Get a blood alcohol level.
- No alcohol on his breath.
Thanks for the supplies.
Anytime! He's seizing! Get some Ativan, 2 mgs.
Where's Tabash? He's with another patient.
- What's he ordered? - Everything.
CBC, lytes, blood cultures, what? - Yes.
All that.
- ABG, chest x-ray? - Yes.
- Dr.
Benton.
Your son is stable at the moment.
What labs have you ordered? We've done a complete septic workup.
I need to know exactly what you've ordered.
What labs, what antibiotics, what Dr.
Benton, your son's heart rate is 170 and his pulse ox is 91 on 100 percent oxygen.
We've taken a chest x-ray, drawn blood for CBC, lytes and ABG sent off blood, urine, endotracheal aspirate and spinal-fluid cultures and started him on 100 milligrams of ampicillin and 6 milligrams of gentamicin.
He was hypotensive with a blood pressure of 30/18 so he's received 5 percent albumin, 10 cc's per kilo.
And we've started dopamine, And we'll titrate to a M.
A.
P.
Of 40.
Now, what you need to know.
What you need to share with this child's mother is that at the moment, the baby is stable but critically ill.
Probably has a serious infection in his blood.
We don't know if his lungs can provide enough oxygen to sustain life.
Unfortunately, we have no choice but to wait and see how he responds to the present therapy.
Let's see how he's doing in an hour.
And that's when we should talk again.
What's your son's name? He doesn't have one.
All right, I got some good news and bad news.
You're gonna tell me both.
The bad news is, they're planning a surprise birthday party for you.
- You did this joke on me this morning.
- This one's real.
I got invited.
I'm not listening.
The good news is, I know you hate your birthday, so I got you out of it.
I do not hate my birthday.
So I told them you cannot make it because you're having dinner with me.
I do not believe a word of this.
How many people have wished you happy birthday? Just Kerry, this morning.
And how many people know that it is your birthday? - You know theirs, right? - We've worked together for years.
What is the one reason why you don't wish someone happy birthday when it is their birthday? - They're planning a surprise party.
- That's all I'm saying.
Why do I feel you've trapped me into this? Trapped you? I saved you.
You should be buying me dinner.
I'll pick you up anytime.
You name the place and You got some gauze out here.
I'm out of here as of an hour ago.
Can you send that Carla Reece chart up to OB, please? - Sure.
I got it.
- Did you say Carla Reece? She just delivered her baby.
- Carla? - You know her? Not really.
I remember her.
She came through the ER a month ago.
She wasn't near being due.
I know.
The baby's only 32 weeks.
A little boy.
- Was he okay? - I don't know.
He's in the NICU.
Apgar was poor.
Had to intubate.
It's touch-and-go.
Is she doing all right? She had no other complications, if that's what you mean.
I don't know how many preemies I've resuscitated but I'm still not used to it.
See you tomorrow.
See you.
Is Maggie taking that woman with the eye pain? No, I'm taking her.
I'm just heading in.
Don't keep the patients waiting.
Dr.
Greene's on a rampage about that.
He'll settle back in.
He just needs a couple more days.
- I keep missing you.
How you doing? - I'm fine.
Feels good to be back.
- Not too soon? - It was nice having time with Rachel.
But a week at home is about all I could take.
- Any word from the police? - They're gonna come by this afternoon.
I gave them a list of patients and family members who might have had a reason to be that angry.
The ones I could remember.
- So you're okay with this? - Yes and no.
It hasn't been the most pleasant experience but it's a wake-up call.
A reminder that I can be abrupt with people, and it'll backfire.
I don't know if that's You've got a five-year-old with a wrist fracture.
A child in pain.
Music to my ears.
Get some lunch later? I'm so sorry.
The chest x-ray showed a diffuse, patchy infiltrate and the endotracheal aspirate showed gram-negative bacteria.
He's got pneumonia, sepsis, premature lungs Respiratory Distress Syndrome.
They just gave him surfactant to try to open up his lungs.
How's Carla doing? She asked me to wait outside in the hall.
You probably haven't shared this with anyone, have you? Your family, people you work with.
You do have friends.
A community.
I hope everything will be all right.
And you need to stop standing in the hall.
Just keep your hands at your sides.
- It hurts! - Yes, I think we know that.
Pulse is 130.
BP is 180 over 95.
Pre-op labs? You been taking a lot of ibuprofen lately? About eight tablets a day.
But that's because I twisted my knee, not because of this stomachache.
- You have a minute? - Sure.
Let's get an upright chest x-ray and give 10 of morphine slow IV push.
That'll help with your pain.
I'll be right back.
I'm just checking.
This is the groaning guy in Exam 2 that Dr.
Greene was concerned about? He's concerned? He's worried the guy's waiting too long for a Surgical consult.
Mr.
Lensky's got a board-like abdomen and guarding in all four quadrants.
- A perfed ulcer? - Sounds like it.
I ordered a film.
Have Anspaugh check it out.
- Colles' fracture.
- Do a closed reduction? His dad still too flipped out to watch? He's sacked out in Curtain 3, having self-medicated with Valium.
That's helpful.
Maybe we should get a lollipop for Russell.
- Fentanyl Oralet? - No.
I'm out.
I'll have to order it.
It may take a while.
- We can try it without.
- All right.
I tell you what we're gonna do, buddy.
We're gonna - I'll get that lollipop.
- Get right on it.
I want to give it a little longer, but the surfactant didn't do much.
He still requires 100 percent oxygen with high pressures on the ventilator.
His mother's gonna want to know everything that might happen.
Every parent in here wants to know what might happen.
We just can't know for sure.
You know I did a Pedes Surgery elective this year but I'm not up to speed on all the sequelae.
Like retinopathy? Exactly.
Although, his eyesight should be the least of our worries.
We need to be more concerned about intraventricular hemorrhage periventricular leukomalacia, necrotizing enterocolitis and in a few weeks, bronchopulmonary dysplasia.
All right, what do we do? I'm concerned about the high vent pressure's causing lung damage.
So I want to switch him over to an oscillating ventilator, and we wait.
- Dr.
Greene, you got a second? - What is it? I got the head CT back on Harry Smith.
- Harry Smith? - The MVA from this morning? It's negative.
No bleed.
But I was talking to his mother.
She said Harry was on his way to a pre-employment physical for a new job.
She also let it drop that she was relieved that the cops didn't find marijuana on him.
Is this leading to helping the patient? His urine is like water.
Check this out.
"Specific gravity, 10.
05.
" I think we should give him Lasix for hyponatremia.
Water intoxication? If he's worried about a urine drug test maybe he thinks he can dilute it or wash out his system.
Transfer that LOL back to her nursing home.
Did you hear from that detective who said he was coming by? Haven't heard, haven't seen.
That's a good thought.
Call the lab and see if his lytes are back.
Does that hurt? That's why Dr.
Ross gave you that shot.
Nurse Hathaway is gonna pull down on your arm I'll push, and we'll pop that bone right here right back in place.
- Ready to start? - Where's my dad? Taking a nap.
But he wanted us to be here with you.
He sings to me.
He sings to you, does he? So you'll do it? I think Dr.
Ross would love to sing to you.
You know, Nurse Hathaway would like to join in but she doesn't know the words.
I believe I do too know the words to whatever it is Dr.
Ross is gonna sing to you.
He//o, Muddah He//o, Faddah Here I am at Camp Grenada It is very entertaining Pop it right there.
And they say we'// have some fun If it stops raining Wrap that up.
I went hiking With Joe Spivy He did develop Poison ivy - You brought me here for this? - I think he perfed his stomach ulcer.
Of course.
It's free air under the diaphragm.
It's a slam dunk, no-brainer.
All right, drop an NG, consent him and redline him to the O.
R.
I realize you needed backup, but any Senior Resident could've handled this.
So please think twice next time.
Good news.
We'll be able to fix you up right away.
- What is it? - You have an ulcer which has eaten through the lining of your stomach but with surgery can be easily repaired.
Surgery? - It's a fairly routine procedure - I can't do surgery.
- It really is the only option.
- No.
I feel better already.
That's the morphine.
Nothing's changed with your condition.
- Wait a second.
Listen to me.
- You listen to me! I will not have surgery! And you can't make me! Now leave me alone.
I wanna go.
Can you tell me why you feel so strongly? Did something happen to you? To somebody else? I'm trying to help you here.
But I can't help you if you leave.
Or if you won't tell me what the problem is.
Of all the stupid things.
Gallbladder.
My dad was such a believer in modern doctors, modern medicines.
"They'll pop this thing out.
I'll be home tomorrow.
" Fifty-eight years old, and he dies having his stupid gallbladder taken out.
And the surgeon.
All he could talk about was how simple it was, no big deal.
Afterwards, he couldn't even look my mother in the eye.
He gave us the news and just spouted some fancy medical words.
All I could think was, "You lying son of a bitch!" We shouldn't have believed him.
How can I believe you? I talked to him about his father's gallbladder operation.
I explained why his surgery was different.
I couldn't get him to budge.
Not much you can do.
He needs to get to the O.
R.
Not to mention, Anspaugh's gonna take my head off one more time.
We can't override the consent for emergency surgery.
No, we can't.
But I read a paper about forme fruste ulcers that spontaneously seal off.
Do a paper-chase search.
See what you find.
Maybe a Hypaque upper GI, see what's going on.
Good idea.
These labs came back for you on Harry Smith.
Sodium, 115? I don't believe it.
I was right.
He's been drinking buckets of water.
He's also waking up if you want to talk to him.
Where's Dr.
Greene? Anything to drink? Sure.
I'll take a pop if you've got one.
Good news.
All the leads you gave us came out clear.
- What? - Yeah.
Everyone checked out.
Patients? Families? Everyone you gave us.
There wasn't anything on anyone? Usually people are glad to hear that.
They don't like things happening in their own back yard.
Right.
Right.
You okay? Sure.
I see you made a pretty quick recovery.
It wasn't as bad as I thought it was gonna be.
We'll keep investigating, of course.
Gotta go.
- Dr.
Greene.
- Later, Carter.
I was right about the water-intoxication guy.
His sodium is 115.
He drank 3 gallons.
That's great.
Great.
Terrific.
Wonderful.
Admit to Medicine.
It's not that it's a better or a worse option.
It just may be the only other thing to consider.
Babies can respond to inhaled nitric oxide and it can improve their oxygenation.
In full-term babies.
Correct.
It's still being studied in premature infants.
We're participating in a national multicenter trial.
There is a small series which shows that nitric improved oxygenation by 50 percent on average.
Now, half of those kids did develop bleeding of the brain but no one knows if the gas caused that.
Bleeding in the brain.
There would be a risk of retardation and cerebral palsy.
But if we keep doing what we're doing now, there's a risk of lung disease.
Yes.
And possible brain damage if the oxygen level falls too low.
That's a hell of a choice.
How do I make that decision? I wish I could answer that question for every parent I talk to every day.
Dr.
Tabash? I'm sorry.
Talk it over with the baby's mother, and let me know soon.
Excuse me.
I'm an idiot, Kerry.
I'm a complete idiot.
Was that the detective you were waiting for? It wasn't an angry patient.
It wasn't a family member of an angry patient.
It wasn't Chris Law.
It wasn't Mr.
Gunther.
It wasn't that crazy guy who was yelling about Krishna.
They checked everybody out? I thought I was remembering it like a puzzle that would come together.
But the Chicago Police Department was nice enough to inform me that I am simply the victim of random violence.
Well, you knew that, patient or no patient.
What I knew is that everything I do I do because I am not the victim.
I treat the victim.
I cure the victim.
I watch them roll the victim out like a piece of meat.
But the truth is, I'm the piece of meat.
We can't think about that.
We're the ones who see what goes on out there.
We know that every day some child won't make it home from school.
Some father won't make it home from work.
But if we allowed ourselves to think that could be us we couldn't walk out our front door.
The problem is, that is us.
No, the problem is, it makes us like everyone else.
Dr.
Anspaugh, I was just coming up to see you.
Where's that perfed ulcer? He should've been out two hours ago.
That's why I wanted to talk.
Mr.
Lensky doesn't want surgery.
Well, nobody wants surgery.
So what? But he doesn't need it.
Of course he does.
There's a hole in his stomach.
If we don't repair that perf, he's at risk for peritonitis, sepsis, death.
If you look, there's the ulcer.
But there actually is no leak.
It sealed itself off against the liver.
This patient was redlined to the O.
R.
Who ordered an upper GI? I did.
- You were supposed to consent him.
- He doesn't want surgery.
- He needs surgery.
- Maybe not.
I found an article that shows he could be treated medically.
Which is what he wants.
You think this is about what he wants? I guess.
A little bit.
Well, you're wrong.
This job is about determining what a patient needs and the best way for us, as surgeons, to meet that need.
And as surgeons, we cut.
As a doctor, if I can find a way to do what my patient wants that's medically acceptable, that's what I should do.
I don't believe I should cut somebody open just because I can.
It bothers me that this patient is willing to risk death rather than undergo a simple surgical procedure.
But it bothers me even more that you're so willing to help him do that.
Sorry.
Mark, I still need you to sign off on these QA reviews.
- I don't have time.
- But I'm off in five.
I just Why don't you just leave them at the desk for me? All right? Done.
Done.
Done.
- You look very nice tonight.
- Thank you.
Can you file these for me? I'll ask Miss Kelly.
- Miss Kelly? - Our temp clerk tonight.
Why do we have a temp? I'm sorry, but I don't think that's any of your business.
Okay.
Good night.
- Good night.
- Want to grab a burger? He is so strange.
Where did we find him? Nina, hi.
Damn! I was supposed to call you.
I hate having you think of it that way.
It's been really busy.
- Good first day back? - Completely fabulous.
Did you call Dr.
Gillum? That PTSD guy? Well, you are post-trauma.
I know I need time to settle in but it's not like I'm a postal worker with an AK-47.
I know you're not.
I'm just trying to help any way I can.
I know, and I appreciate it.
I'm fine.
Everything's getting back to normal.
I don't like you trying to cover with me.
I don't like you trying to be a shrink with me.
How's Rachel doing? She's sleeping over at a friend's house tonight.
Great.
Tell her I say hi.
Sure.
- How are you doing? - How is she? Remarkably well, considering.
She's pretty strong.
I wanted to apologize for my behavior this morning in the delivery.
Thank you, but it's unnecessary.
I've never met a father who could handle it sensibly, calmly, maturely.
If I ever do, that's the guy I'm really gonna slap around.
Today was the first day I was ever afraid.
Well, I'm glad to hear that.
- Better get back in here.
- I'll check on her before I leave.
I made the bed.
Isn't that the stupidest thing you've ever seen? I spoke to Dr.
Tabash.
He presented another option for the baby we should consider.
There are a lot of serious risks involved.
So I'm going to try to explain them to you.
Then we have a decision to make.
You don't have to change for me.
I'm not changing for you.
You said we were gonna grab a burger.
We can get some burgers at the Pump Room.
I'm not wearing scrubs to the Pump Room.
I don't know.
I think it'd be rather daring.
Surprise! Happy birthday! Oh, God! I hate you for this.
It worked out well, don't you think? Surprise, girl! That was great.
- What are you doing? - Waiting for you.
Come on.
Right this way.
- What are you doing? - Come on.
Come on.
Just come over here.
Have a seat.
Okay.
- What's this? - A little something for you.
A garage-door opener! Go ahead.
Try it.
- I always wanted one of these.
- I know.
- You always said they were stupid.
- They are stupid.
I don't get why a person can't just open the damn door.
This is the nicest thing you've ever done for me.
That's pretty pathetic.
I love it.
I love it.
Let's have a beer.
Go ahead.
This is special.
I love having 20 people over especially when I have so much to serve them.
Peel an orange.
Would you lighten up? They brought booze.
Okay.
I'll lighten up.
I'll just have a sip of this milk.
You just drink that right out of the carton? What's wrong with that? Well, it's just kind of a guy thing to do.
You know.
So what is all this about? What is what about? This little dance you did today.
This party.
You.
I know you haven't had very good birthdays the last couple of years.
- The ones I spent with you? - The ones I forgot.
I just thought it was time for you to have a nice one.
You want a sip of milk? Yes, I would love a sip of this milk.
Thank you.
Thank you.
Dr.
Weaver.
Excuse me.
- Can I talk to you for a minute? - Sure.
I know this isn't the right time or place, but I was curious.
What would be involved with getting into Emergency Medicine? What do you mean? To change one's Residency, would you have to redo your intern year? Has "one" talked to Dr.
Greene about this? You saw how he was in the hall.
Happy birthday to you Happy birthday to you Happy birthday, dear Caro/ Happy birthday to you Oh, my God! Come on, blow them out! There are so many candles on this cake.
What am I, 55? Wait! Hold on! One second.
Almost forgot.
Wait a minute! Beautiful.
What's that? It's so your wishes come true.
- Make it a good one.
- All right.
All right, Carol.
You go, girl! Oh, my God.
You still look so young.
Two of the best transplant surgeons let us look over their shoulders, and you just leave? Is that a problem? - Okay, I'll stay on the couch.
- Me too.
- I'm looking for a head doctor.
- Which one? Bald white guy, little glasses? Great! Just walk away! Is Dr.
Benton done with that thyroidectomy? So he's still in there? - Dr.
Benton.
- Carter, what are you doing here? Let's get an ABG in 20 minutes.
I thought you were covering the ER.
I'm on in a few.
We need to talk.
Make it fast.
I've got two admissions, a clinic and an aneurysm.
I've been thinking about that kidney case when I left to check on the patients during the debriefing.
Instead of listening to two of the finest surgeons in the country? I guess so.
And I've just been wondering.
Maybe I'm in the wrong place.
If you're still here in two minutes, you are.
I mean surgery.
Obviously, I love it, and I feel challenged by it.
But are you ever not quite satisfied? Carter, sometimes the patient dies.
- I know.
But otherwise.
- Otherwise what? Well, it just feels like sometimes they exist for us to do procedures.
That's why they're here.
We don't need to know anything about them? Like how worried they are or where they went to high school or whether they like cats or dogs? What are you talking about? I like to know the other stuff.
What for? I mean, if you Damn! Listen, we'll talk later.
It was at least 50 questions about my family background.
Nothing like the head of Security to make you feel insecure.
He almost withheld my ID because I didn't know my stepmom's maiden name.
He didn't cut you slack on that picture either.
You'd think I was trying to enter the White House.
Which is easier.
I've done it.
- Can you get these over to Radiology? - Now? Unless you're doing something urgent that I can't quite see.
Go.
Dr.
Ross, Pedes called.
You're covering deliveries for John Lavagnino.
Broken kneecap.
All right.
Good morning to you.
Not for Anna.
She just had her security clearance interview.
Did you get strip-searched? Checked for track marks? Practically.
They're cracking down because of what happened to Mark.
- He starts back today? - I wish he'd take another week.
Let's make sure we keep his load light for the first few days.
I want him helping me plan Carol's surprise birthday party.
- Doug! - Happy birthday, Carol.
I got vomiting and diarrhea in 4.
Happy birthday.
And I'm taking the quadruple bounce-back migraine in 5.
Nothing like a little drug-seeking behavior to start your day.
You promised you wouldn't tell anybody about my birthday.
- That was last year.
- You told everybody then too.
At least I'm consistent.
All right, coffee can wait.
What's this? It's a coffeepot.
That is not a coffeepot.
- It's called a French press.
- No more aluminum percolator? We're gonna have great coffee.
Which can wait.
- What's that? - The microwave.
- I'm heating up some cinnamon buns.
- The microwave.
- I always wanted a microwave.
- I know.
You wouldn't let me get one.
You said it broke down the vitamins.
I know.
I'm sorry.
I was wrong.
Come back over here.
This is nice.
I mean, this is really nice.
- What happened? - It's getting close, 9 centimeters.
- I'm all right.
- She failed tocolysis.
Her contractions are strong.
They went from 4 to 9 in no time.
Why didn't you call me? Last time they gave me that stuff, and it was fine.
- Couldn't you have done something else? - This baby's coming.
It's coming? Two months early? - I know that.
- You should've called me.
I just did, hoping you'd want to participate in the birth.
If that's what you'd like to do, I suggest you gown up.
- Dr.
Greene, right? How are you? - I'm fine, thank you.
Who are you? Anna Del Amico.
We met last week.
We didn't actually meet.
I was there when you were attacked.
- In the men's room? - In the Trauma Room afterwards.
I don't remember either room, so I don't remember you either.
I start my Emergency Residency in July.
I'm doing ER Pedes until then.
That was my first day.
I'm sorry it had to be so exciting.
I'm just glad you're okay.
So welcome back.
Thank you.
Where is everybody? - What you doing here? - Getting back to work.
Doug and Carol are bringing in an MVA.
- Hey, how are you doing? - Welcome back.
Nice to be back.
What do we got? - Bicycle versus tour bus.
- Don't worry.
We got it.
Just take it easy.
Settle in.
Nice and easy.
Here we go! Dr.
Greene! You look great.
OB needs you for that delivery.
Find Dr.
Del Amico.
See if she can take it.
I'll talk to you later.
- She's at the desk.
- Who? - Dr.
Del Amico.
She's at the desk.
- Oh, right.
Thanks.
- Help me shift her down.
- Breathe, Carla.
Come on, baby.
You can do it.
- How much mag you give her? - Six grams.
I gave three an hour until she hit 4 centimeters.
Dorgan, scalp electrode.
Keep breathing.
You're doing great.
Dorgan? What kind of name is that? Irish, through and through.
We've experience having a lot of babies.
Is she at risk for chorioamnionitis? Come on, breathe! Don't yell at me, damn it! - You give her antenatal steroids? - Twelve milligrams betamethasone.
And her blood sugar? She's got gestational diabetes.
You're doing great.
Hang in there.
Not much longer.
You'll be able to push soon.
What about a second dose? This baby's gonna have RDS! What is RDS? It's okay.
It just means the baby's lungs haven't matured yet.
- What? - It's okay.
Hold her hand! Help her breathe! Help her focus! That's your only job here.
Get over there and help the mother of your child.
There'll be two additional security cameras here.
- And two at the employees' entrance.
- Right.
The ambulance-bay doors will be changed to bulletproof glass which we'll also add to Triage.
The hospital agreed to additional armed security in your waiting room.
And the bathrooms? Any cameras in there? Unfortunately, privacy issues won't allow us to do that.
My assailant's privacy would've definitely been violated.
We can only do what we can do.
Thank you, Mr.
Biggers.
It's nice to see you, but what are you doing here? Working.
It's nice to see you too, Chuny.
These additional security measures may not help, but they can't hurt.
Everyone's overreacting.
What we should change is the way we deal with patients and their families.
- They're a pain in the ass.
- Your compassion knows no bounds.
Detective Warrington called.
Can't make it by till later this afternoon.
You think a patient or family member did this? I think that gives them a good reason.
Look.
Louise Pierson.
Ankle x-ray.
Three hours ago.
Where is it? Discharge orders written almost 2 hours ago.
Chart's still here, so the guy's still here.
Come on! Med-Surg admission, Neuro consult, ETA 7:15 this morning.
Where are they? We keep these people hanging around.
I'd get pissed off enough to clobber somebody.
Before Records clobbers me, I need you to sign off these charts.
I got them.
I'm fine.
- Push! You're almost there! - Come on.
Keep going.
- I'm Del Amico from Pedes.
- Janet Coburn.
- I thought Ross was covering.
- He's got a teenager MVA.
This is Carla Reece: Mother.
Peter Benton: Father.
Hi.
Just keep pushing so I can take a look at your baby.
- Mr.
Benton, how are you doing? - It's Dr.
Benton, Surgical Resident.
- You're new here? - Yes, from Children's in Philadelphia.
- Are you a Resident? - Correct.
How many deliveries did you attend over there? I stopped counting around 200.
We've got a late decel here.
- Carla's at 32 weeks.
- Any meconium? - Fluid's clear.
- Heart rate's dropping.
- Where's the NICU nurse? - On her way.
- Down to 120.
- Why isn't he coming? - He's coming, baby.
- Let's get this baby out of here.
- I need vacuum extraction.
- Why vacuum extraction? - We're at 100 here.
- That's why.
- Number for Respiratory Therapy? - Three-three-nine-four.
I brought some stuff in today because I knew you'd be starting back.
What are you doing? I know you'll be a little resistant to this but you'll feel safer if you carry something on you.
What is this stuff? I've got cops in my family, so I can get anything.
Electronic stun gun, personal taser.
- I don't think so.
- At least take the pepper spray.
I appreciate it, really, but it's not for me.
I'm not suggesting you pack a gun, although that's what I do.
- You carry a gun? - Under the front seat of my car.
I was at the drive-in once, waiting for fries and this punk sticks a knife in my face.
He wants my wallet.
So I reach under the seat, grab the.
357 stick it up his nose, and could that kid run! - Dr.
Greene, welcome back.
- Thanks.
Listen, thanks, Maggie, but I'll pass on the armaments.
Are you in the ER all day? Because I'll need your help.
I don't have full mobility yet for procedures.
- What is all this stuff? - I was trying to get Dr.
Greene to - Oh, my God! - Sit down! Oh, my God! Maggie, help me! Just sit! Just sit! I'll get a nurse! I'll be right back.
Don't move.
Don't touch your eyes.
That's it.
Push! Push! - Come on.
Breathe.
- We got him! It's okay, baby.
It's okay.
Blue and floppy.
Ready the liter.
What is it? I can't hear him.
- What's going on? What's wrong? - DeLee suction.
- Please tell me what's going on.
- I don't like his color.
Come on, little guy.
Pick up for us.
Let's go.
- What's the Apgar? - Zero for color.
Peter, back off! Let her work! Muscle tone, zero.
One for reflex.
Two for heart rate.
One-minute Apgar, 4 out of 10.
You gotta do something! Let's go! Tell me what's going on.
It's okay, baby.
It's okay.
They got him.
- He's got retractions.
- I need to tube him.
Two-point-five.
Heart rate down.
Eighty-five.
Start compressions.
Draw.
02 epi.
Call the NICU.
Tell them we're on the way.
I'm sorry.
- I know it's not funny, but - No, it's funny.
My whole life is just one big funfest.
Anspaugh hates me, Benton looks at me like I'm some kind of an alien.
Those things are in your favor.
Right.
Thank you.
When you were thinking about med school you were willing to start over? All that work? As opposed to the 6 more years of Surgical Residency ahead of you? I see your point.
- You back among the living? - Absolutely.
We've got an MVA coming in six or seven minutes.
It's not my place to say, but he looks kind of bad.
You okay there? I'm just going to get everything ready for you.
Be right back.
Just hang in there.
You're almost there.
What are we gonna do? Have you seen him? I'll check on him as soon as you're settled.
Just take it easy.
Just be a couple of more minutes.
Housekeeping hasn't finished.
One, two, three.
Rib? - We'll kick you out.
- I'm fine.
Normal vital signs.
Oxygen, 5 liters.
GCS, 11.
Mind if I steal some saline? Help yourself.
Pupils are equal and reactive.
No hemotympanum.
Chest is clear.
Abdomen soft and flat.
Pulse is 80.
BP, 120 over 75.
- What's his name? - Harry Smith.
Harry, can you hear me? Do you know where you are? - Let's order something.
- CBC, Chem-7, type and screen.
- You want to dip a urine? - Get a C-spine, chest and pelvis.
Police said it was a DUI? He was swerving on the Eisenhower, going 35.
He hit a light pole.
- Get a blood alcohol level.
- No alcohol on his breath.
Thanks for the supplies.
Anytime! He's seizing! Get some Ativan, 2 mgs.
Where's Tabash? He's with another patient.
- What's he ordered? - Everything.
CBC, lytes, blood cultures, what? - Yes.
All that.
- ABG, chest x-ray? - Yes.
- Dr.
Benton.
Your son is stable at the moment.
What labs have you ordered? We've done a complete septic workup.
I need to know exactly what you've ordered.
What labs, what antibiotics, what Dr.
Benton, your son's heart rate is 170 and his pulse ox is 91 on 100 percent oxygen.
We've taken a chest x-ray, drawn blood for CBC, lytes and ABG sent off blood, urine, endotracheal aspirate and spinal-fluid cultures and started him on 100 milligrams of ampicillin and 6 milligrams of gentamicin.
He was hypotensive with a blood pressure of 30/18 so he's received 5 percent albumin, 10 cc's per kilo.
And we've started dopamine, And we'll titrate to a M.
A.
P.
Of 40.
Now, what you need to know.
What you need to share with this child's mother is that at the moment, the baby is stable but critically ill.
Probably has a serious infection in his blood.
We don't know if his lungs can provide enough oxygen to sustain life.
Unfortunately, we have no choice but to wait and see how he responds to the present therapy.
Let's see how he's doing in an hour.
And that's when we should talk again.
What's your son's name? He doesn't have one.
All right, I got some good news and bad news.
You're gonna tell me both.
The bad news is, they're planning a surprise birthday party for you.
- You did this joke on me this morning.
- This one's real.
I got invited.
I'm not listening.
The good news is, I know you hate your birthday, so I got you out of it.
I do not hate my birthday.
So I told them you cannot make it because you're having dinner with me.
I do not believe a word of this.
How many people have wished you happy birthday? Just Kerry, this morning.
And how many people know that it is your birthday? - You know theirs, right? - We've worked together for years.
What is the one reason why you don't wish someone happy birthday when it is their birthday? - They're planning a surprise party.
- That's all I'm saying.
Why do I feel you've trapped me into this? Trapped you? I saved you.
You should be buying me dinner.
I'll pick you up anytime.
You name the place and You got some gauze out here.
I'm out of here as of an hour ago.
Can you send that Carla Reece chart up to OB, please? - Sure.
I got it.
- Did you say Carla Reece? She just delivered her baby.
- Carla? - You know her? Not really.
I remember her.
She came through the ER a month ago.
She wasn't near being due.
I know.
The baby's only 32 weeks.
A little boy.
- Was he okay? - I don't know.
He's in the NICU.
Apgar was poor.
Had to intubate.
It's touch-and-go.
Is she doing all right? She had no other complications, if that's what you mean.
I don't know how many preemies I've resuscitated but I'm still not used to it.
See you tomorrow.
See you.
Is Maggie taking that woman with the eye pain? No, I'm taking her.
I'm just heading in.
Don't keep the patients waiting.
Dr.
Greene's on a rampage about that.
He'll settle back in.
He just needs a couple more days.
- I keep missing you.
How you doing? - I'm fine.
Feels good to be back.
- Not too soon? - It was nice having time with Rachel.
But a week at home is about all I could take.
- Any word from the police? - They're gonna come by this afternoon.
I gave them a list of patients and family members who might have had a reason to be that angry.
The ones I could remember.
- So you're okay with this? - Yes and no.
It hasn't been the most pleasant experience but it's a wake-up call.
A reminder that I can be abrupt with people, and it'll backfire.
I don't know if that's You've got a five-year-old with a wrist fracture.
A child in pain.
Music to my ears.
Get some lunch later? I'm so sorry.
The chest x-ray showed a diffuse, patchy infiltrate and the endotracheal aspirate showed gram-negative bacteria.
He's got pneumonia, sepsis, premature lungs Respiratory Distress Syndrome.
They just gave him surfactant to try to open up his lungs.
How's Carla doing? She asked me to wait outside in the hall.
You probably haven't shared this with anyone, have you? Your family, people you work with.
You do have friends.
A community.
I hope everything will be all right.
And you need to stop standing in the hall.
Just keep your hands at your sides.
- It hurts! - Yes, I think we know that.
Pulse is 130.
BP is 180 over 95.
Pre-op labs? You been taking a lot of ibuprofen lately? About eight tablets a day.
But that's because I twisted my knee, not because of this stomachache.
- You have a minute? - Sure.
Let's get an upright chest x-ray and give 10 of morphine slow IV push.
That'll help with your pain.
I'll be right back.
I'm just checking.
This is the groaning guy in Exam 2 that Dr.
Greene was concerned about? He's concerned? He's worried the guy's waiting too long for a Surgical consult.
Mr.
Lensky's got a board-like abdomen and guarding in all four quadrants.
- A perfed ulcer? - Sounds like it.
I ordered a film.
Have Anspaugh check it out.
- Colles' fracture.
- Do a closed reduction? His dad still too flipped out to watch? He's sacked out in Curtain 3, having self-medicated with Valium.
That's helpful.
Maybe we should get a lollipop for Russell.
- Fentanyl Oralet? - No.
I'm out.
I'll have to order it.
It may take a while.
- We can try it without.
- All right.
I tell you what we're gonna do, buddy.
We're gonna - I'll get that lollipop.
- Get right on it.
I want to give it a little longer, but the surfactant didn't do much.
He still requires 100 percent oxygen with high pressures on the ventilator.
His mother's gonna want to know everything that might happen.
Every parent in here wants to know what might happen.
We just can't know for sure.
You know I did a Pedes Surgery elective this year but I'm not up to speed on all the sequelae.
Like retinopathy? Exactly.
Although, his eyesight should be the least of our worries.
We need to be more concerned about intraventricular hemorrhage periventricular leukomalacia, necrotizing enterocolitis and in a few weeks, bronchopulmonary dysplasia.
All right, what do we do? I'm concerned about the high vent pressure's causing lung damage.
So I want to switch him over to an oscillating ventilator, and we wait.
- Dr.
Greene, you got a second? - What is it? I got the head CT back on Harry Smith.
- Harry Smith? - The MVA from this morning? It's negative.
No bleed.
But I was talking to his mother.
She said Harry was on his way to a pre-employment physical for a new job.
She also let it drop that she was relieved that the cops didn't find marijuana on him.
Is this leading to helping the patient? His urine is like water.
Check this out.
"Specific gravity, 10.
05.
" I think we should give him Lasix for hyponatremia.
Water intoxication? If he's worried about a urine drug test maybe he thinks he can dilute it or wash out his system.
Transfer that LOL back to her nursing home.
Did you hear from that detective who said he was coming by? Haven't heard, haven't seen.
That's a good thought.
Call the lab and see if his lytes are back.
Does that hurt? That's why Dr.
Ross gave you that shot.
Nurse Hathaway is gonna pull down on your arm I'll push, and we'll pop that bone right here right back in place.
- Ready to start? - Where's my dad? Taking a nap.
But he wanted us to be here with you.
He sings to me.
He sings to you, does he? So you'll do it? I think Dr.
Ross would love to sing to you.
You know, Nurse Hathaway would like to join in but she doesn't know the words.
I believe I do too know the words to whatever it is Dr.
Ross is gonna sing to you.
He//o, Muddah He//o, Faddah Here I am at Camp Grenada It is very entertaining Pop it right there.
And they say we'// have some fun If it stops raining Wrap that up.
I went hiking With Joe Spivy He did develop Poison ivy - You brought me here for this? - I think he perfed his stomach ulcer.
Of course.
It's free air under the diaphragm.
It's a slam dunk, no-brainer.
All right, drop an NG, consent him and redline him to the O.
R.
I realize you needed backup, but any Senior Resident could've handled this.
So please think twice next time.
Good news.
We'll be able to fix you up right away.
- What is it? - You have an ulcer which has eaten through the lining of your stomach but with surgery can be easily repaired.
Surgery? - It's a fairly routine procedure - I can't do surgery.
- It really is the only option.
- No.
I feel better already.
That's the morphine.
Nothing's changed with your condition.
- Wait a second.
Listen to me.
- You listen to me! I will not have surgery! And you can't make me! Now leave me alone.
I wanna go.
Can you tell me why you feel so strongly? Did something happen to you? To somebody else? I'm trying to help you here.
But I can't help you if you leave.
Or if you won't tell me what the problem is.
Of all the stupid things.
Gallbladder.
My dad was such a believer in modern doctors, modern medicines.
"They'll pop this thing out.
I'll be home tomorrow.
" Fifty-eight years old, and he dies having his stupid gallbladder taken out.
And the surgeon.
All he could talk about was how simple it was, no big deal.
Afterwards, he couldn't even look my mother in the eye.
He gave us the news and just spouted some fancy medical words.
All I could think was, "You lying son of a bitch!" We shouldn't have believed him.
How can I believe you? I talked to him about his father's gallbladder operation.
I explained why his surgery was different.
I couldn't get him to budge.
Not much you can do.
He needs to get to the O.
R.
Not to mention, Anspaugh's gonna take my head off one more time.
We can't override the consent for emergency surgery.
No, we can't.
But I read a paper about forme fruste ulcers that spontaneously seal off.
Do a paper-chase search.
See what you find.
Maybe a Hypaque upper GI, see what's going on.
Good idea.
These labs came back for you on Harry Smith.
Sodium, 115? I don't believe it.
I was right.
He's been drinking buckets of water.
He's also waking up if you want to talk to him.
Where's Dr.
Greene? Anything to drink? Sure.
I'll take a pop if you've got one.
Good news.
All the leads you gave us came out clear.
- What? - Yeah.
Everyone checked out.
Patients? Families? Everyone you gave us.
There wasn't anything on anyone? Usually people are glad to hear that.
They don't like things happening in their own back yard.
Right.
Right.
You okay? Sure.
I see you made a pretty quick recovery.
It wasn't as bad as I thought it was gonna be.
We'll keep investigating, of course.
Gotta go.
- Dr.
Greene.
- Later, Carter.
I was right about the water-intoxication guy.
His sodium is 115.
He drank 3 gallons.
That's great.
Great.
Terrific.
Wonderful.
Admit to Medicine.
It's not that it's a better or a worse option.
It just may be the only other thing to consider.
Babies can respond to inhaled nitric oxide and it can improve their oxygenation.
In full-term babies.
Correct.
It's still being studied in premature infants.
We're participating in a national multicenter trial.
There is a small series which shows that nitric improved oxygenation by 50 percent on average.
Now, half of those kids did develop bleeding of the brain but no one knows if the gas caused that.
Bleeding in the brain.
There would be a risk of retardation and cerebral palsy.
But if we keep doing what we're doing now, there's a risk of lung disease.
Yes.
And possible brain damage if the oxygen level falls too low.
That's a hell of a choice.
How do I make that decision? I wish I could answer that question for every parent I talk to every day.
Dr.
Tabash? I'm sorry.
Talk it over with the baby's mother, and let me know soon.
Excuse me.
I'm an idiot, Kerry.
I'm a complete idiot.
Was that the detective you were waiting for? It wasn't an angry patient.
It wasn't a family member of an angry patient.
It wasn't Chris Law.
It wasn't Mr.
Gunther.
It wasn't that crazy guy who was yelling about Krishna.
They checked everybody out? I thought I was remembering it like a puzzle that would come together.
But the Chicago Police Department was nice enough to inform me that I am simply the victim of random violence.
Well, you knew that, patient or no patient.
What I knew is that everything I do I do because I am not the victim.
I treat the victim.
I cure the victim.
I watch them roll the victim out like a piece of meat.
But the truth is, I'm the piece of meat.
We can't think about that.
We're the ones who see what goes on out there.
We know that every day some child won't make it home from school.
Some father won't make it home from work.
But if we allowed ourselves to think that could be us we couldn't walk out our front door.
The problem is, that is us.
No, the problem is, it makes us like everyone else.
Dr.
Anspaugh, I was just coming up to see you.
Where's that perfed ulcer? He should've been out two hours ago.
That's why I wanted to talk.
Mr.
Lensky doesn't want surgery.
Well, nobody wants surgery.
So what? But he doesn't need it.
Of course he does.
There's a hole in his stomach.
If we don't repair that perf, he's at risk for peritonitis, sepsis, death.
If you look, there's the ulcer.
But there actually is no leak.
It sealed itself off against the liver.
This patient was redlined to the O.
R.
Who ordered an upper GI? I did.
- You were supposed to consent him.
- He doesn't want surgery.
- He needs surgery.
- Maybe not.
I found an article that shows he could be treated medically.
Which is what he wants.
You think this is about what he wants? I guess.
A little bit.
Well, you're wrong.
This job is about determining what a patient needs and the best way for us, as surgeons, to meet that need.
And as surgeons, we cut.
As a doctor, if I can find a way to do what my patient wants that's medically acceptable, that's what I should do.
I don't believe I should cut somebody open just because I can.
It bothers me that this patient is willing to risk death rather than undergo a simple surgical procedure.
But it bothers me even more that you're so willing to help him do that.
Sorry.
Mark, I still need you to sign off on these QA reviews.
- I don't have time.
- But I'm off in five.
I just Why don't you just leave them at the desk for me? All right? Done.
Done.
Done.
- You look very nice tonight.
- Thank you.
Can you file these for me? I'll ask Miss Kelly.
- Miss Kelly? - Our temp clerk tonight.
Why do we have a temp? I'm sorry, but I don't think that's any of your business.
Okay.
Good night.
- Good night.
- Want to grab a burger? He is so strange.
Where did we find him? Nina, hi.
Damn! I was supposed to call you.
I hate having you think of it that way.
It's been really busy.
- Good first day back? - Completely fabulous.
Did you call Dr.
Gillum? That PTSD guy? Well, you are post-trauma.
I know I need time to settle in but it's not like I'm a postal worker with an AK-47.
I know you're not.
I'm just trying to help any way I can.
I know, and I appreciate it.
I'm fine.
Everything's getting back to normal.
I don't like you trying to cover with me.
I don't like you trying to be a shrink with me.
How's Rachel doing? She's sleeping over at a friend's house tonight.
Great.
Tell her I say hi.
Sure.
- How are you doing? - How is she? Remarkably well, considering.
She's pretty strong.
I wanted to apologize for my behavior this morning in the delivery.
Thank you, but it's unnecessary.
I've never met a father who could handle it sensibly, calmly, maturely.
If I ever do, that's the guy I'm really gonna slap around.
Today was the first day I was ever afraid.
Well, I'm glad to hear that.
- Better get back in here.
- I'll check on her before I leave.
I made the bed.
Isn't that the stupidest thing you've ever seen? I spoke to Dr.
Tabash.
He presented another option for the baby we should consider.
There are a lot of serious risks involved.
So I'm going to try to explain them to you.
Then we have a decision to make.
You don't have to change for me.
I'm not changing for you.
You said we were gonna grab a burger.
We can get some burgers at the Pump Room.
I'm not wearing scrubs to the Pump Room.
I don't know.
I think it'd be rather daring.
Surprise! Happy birthday! Oh, God! I hate you for this.
It worked out well, don't you think? Surprise, girl! That was great.
- What are you doing? - Waiting for you.
Come on.
Right this way.
- What are you doing? - Come on.
Come on.
Just come over here.
Have a seat.
Okay.
- What's this? - A little something for you.
A garage-door opener! Go ahead.
Try it.
- I always wanted one of these.
- I know.
- You always said they were stupid.
- They are stupid.
I don't get why a person can't just open the damn door.
This is the nicest thing you've ever done for me.
That's pretty pathetic.
I love it.
I love it.
Let's have a beer.
Go ahead.
This is special.
I love having 20 people over especially when I have so much to serve them.
Peel an orange.
Would you lighten up? They brought booze.
Okay.
I'll lighten up.
I'll just have a sip of this milk.
You just drink that right out of the carton? What's wrong with that? Well, it's just kind of a guy thing to do.
You know.
So what is all this about? What is what about? This little dance you did today.
This party.
You.
I know you haven't had very good birthdays the last couple of years.
- The ones I spent with you? - The ones I forgot.
I just thought it was time for you to have a nice one.
You want a sip of milk? Yes, I would love a sip of this milk.
Thank you.
Thank you.
Dr.
Weaver.
Excuse me.
- Can I talk to you for a minute? - Sure.
I know this isn't the right time or place, but I was curious.
What would be involved with getting into Emergency Medicine? What do you mean? To change one's Residency, would you have to redo your intern year? Has "one" talked to Dr.
Greene about this? You saw how he was in the hall.
Happy birthday to you Happy birthday to you Happy birthday, dear Caro/ Happy birthday to you Oh, my God! Come on, blow them out! There are so many candles on this cake.
What am I, 55? Wait! Hold on! One second.
Almost forgot.
Wait a minute! Beautiful.
What's that? It's so your wishes come true.
- Make it a good one.
- All right.
All right, Carol.
You go, girl! Oh, my God.
You still look so young.