ER s04e08 Episode Script
Freak Show
ER Previously on ER - Are you firing me? - Jeanie, I'm sorry.
Oh, jeez! Your clinic proposal.
That's tonight, isn't it? Yeah, Oak Park, 7:00.
That's what we said.
Your husband lied to you about his condition! He's going to die! Peter Benton, Rocket Romano.
Dr.
Benton.
Hey, Lizzie's talked about you.
I don't usually do this kind of thing.
Sure.
That's what they all say.
My family has a few bucks and everything changes? A few bucks? Is that what it is to you? Freak Show Carol! Man, look at you! I hardly sleep a wink on the redeye and you're jogging and smiling.
There's nothing like a visit with the folks to make you appreciate home.
The staff will be thrilled.
You haven't been too high on the popularity list lately.
- I've been kind of a jerk.
- Worse.
- Pain in the ass? - Keep going.
- Total schmuck.
- Bingo.
We all understood.
It's just we're glad you're getting over it.
You know, that meant a lot to Doug, you showing up like that.
It meant a lot to me too.
I almost forgot.
I found this when I unpacked.
- "CH"? - Yeah.
"Carol Hathaway.
" It's from "DR.
" - Did you read it? - No.
But I was tempted.
Anna? Can you come in here and give me a hand? - What have you got? - A shoulder reduction on a boxer.
Coach made him take ballet.
I'll do traction.
Then I will give you countertraction.
Thanks, Lily.
- So how have you been? - Fine.
On my count.
One, two, three.
- Seen any interesting cases? - No.
Not really.
- Done any interesting procedures? - Nope.
- You wanna grab some breakfast? - I'm not hungry.
Thanks.
- What? Are you still angry? - I'm over it.
You sure? Can we just focus on the patient, please? - Hey! Cute little bugger.
- Thanks.
I bet he keeps you pretty busy.
Actually, he lives with his mother.
So I see him when I can.
What about you? You got any kids? None they've been able to pin on me.
You know, Peter, you've been on my mind lately.
You made the short list for my team.
You still interested? Sure.
- I just have a couple of reservations.
- Reservations? Yeah.
I need a team player.
Someone who is compatible with Lizzie Corday.
Now, word has it you and she have had a couple of run-ins.
We've had our differences, but we've worked them out.
Differences can be healthy.
Can you keep up with her? Absolutely.
Do you have the time? Sure.
Great.
We'll do a trial run, see if we're all compatible.
And then I'll make my final decision.
What's going on? Mark, when did you get back? Hi.
Late last night.
- What are these people doing here? - They're patients for your new clinic.
No.
The clinic doesn't open until next week.
You said to put the announcement in for today.
No.
I said next week.
Oh, man! Oh, I'm really sorry.
Is there anything that I can do? Start giving out numbers.
Hey, everybody, listen up.
I need volunteers to come back next week.
You'll get on the front of the line.
No? Then everyone has to be really patient.
Tell that to my boss.
- Bryan, baby.
- Oh, miss I can't keep standing like this.
I've got the gout.
Take a chair.
Anyone else need a chair? Stop jumping up and down.
Wait over in Chairs.
Take a number.
Twenty-seven? I might as well be waiting six hours in the ER.
Go ahead.
That would help me out a lot.
Carol? Kerry, hi.
Did Mark tell you about the scheduling snafu? Very unfortunate.
I need to talk with you.
I'm a little busy now.
Weren't you scheduled to work the ER? I had to take the day off to run the clinic.
- Could you spare anyone to help? - When I signed off on the clinic you promised to find your own personnel and it wouldn't impinge on your regular duties.
I could turf the runny noses, BP checks over to the ER and have your personnel handle them.
- Okay.
I'll give you Yosh Takata.
- Who? Nursing Administration.
Excuse me.
Transfer from upstairs.
Why don't you talk to my friend at the Gay and Lesbian Defense Fund? They represent people with HIV and AIDS who have been fired.
Maggie, thanks for your concern, but that's not what happened.
Sure.
You're the best P.
A.
we have.
I just hate to see you give up.
I'm not giving up.
I'm moving on.
Al's in Atlanta checking out leads and a couple of construction jobs.
But it's illegal for them to fire you for being HIV-positive.
- You think that's why they fired me? - You don't? No.
They could've done that last year.
It's because of the budget.
- Hi.
- Hi.
- I missed you.
- Me too.
You did? Because you didn't call.
Well, we were on the road the whole time but So I wasn't able to wrap it.
What's this? Oh, it's beautiful! Thank you! I love it! Oh, my-! Would you latch it for me? Sure.
The guy at the shop said that it is a genuine diamond.
A real diamond.
No one has ever gotten me a real diamond before, Mark.
I love it.
- Pardon us.
- Welcome back.
There's no place like home.
This coffee's terrible.
I'm really awful in the kitchen.
Sorry.
I think it tastes really good.
- What do we got? - Twelve-year-old boy.
Hit-and-run on his way to school.
GCS 7.
Got routine blood work.
Chest and abdominal films, C-spine.
BP's funky, 80 palp.
Gave him two units O-neg.
The name on this notebook says Rodney Price.
There's a mass in the upper left quadrant.
Abdomen is distended.
Crit's falling, 26.
Bleeding internally.
I'll hang another unit on the rapid infuser.
- He ruptured his spleen.
- Biggest spleen I've ever felt.
- Got the wet reads.
- Great.
Here's the shadow.
That's the hematoma pressing down on the splenic flexure.
- Looks like a rupture.
- No, no.
Wait a minute.
Wait a minute.
The film's mislabeled.
The gastric bubble is under the right diaphragm instead of the left.
But with a splenic rupture, the gastric bubble can be displaced.
No, no, no.
Not that much it can't Whoa, whoa, wait a minute! That's not his spleen.
That's his liver.
The liver's in the wrong place.
- Backwards? - His abdominal organs are reversed.
That's remarkable.
Let's get him up to Surgery! Move! Ever do a case like this before? No.
This is one in a million.
All right, everybody.
Page Romano! - You have previous clinic experience? - A little.
- Where would that have been? - Chart Review.
You don't see many patients in Chart Review.
No.
But I know a lot about them.
We'll have to double up on patients in here.
- Be with you in a minute.
- You said that an hour ago.
Sign in patients, start a chart, and check their vitals.
- Where? - Out here.
If anyone seems the least bit emergent, take them over to ER Triage.
Can you handle that? - If I have any questions, I'll holler.
- Great.
Mark! Oh, bring the kid out here, please.
- Do you have a sec? - I gotta get to Radiology.
But I got a triple failure otitis media that needs a scrip for Augmentin.
All right.
How's it going, Carol? You know, I would've been organized by next week.
You couldn't help me at all today? Well, it's a little busy not having Doug here.
- But I'll see what I can do.
- All right.
I appreciate it.
- I think Carol's mad at me.
- No.
She's just got a lot on her mind.
That hospital lawyer dropped off these papers for you to sign.
They're urgent, about the civil rights case.
- File them in my box.
- Along with the others? Yeah.
I'm not gonna let these bastards get to me.
The man of the hour's arrived.
- This is the situs inversus? - It sure is.
Fantastic case, Peter.
I've never seen one in the flesh before.
It's worth considering a case report.
I'm actually thinking of running a literature review.
I took the liberty.
There's nothing on abdominal situs inversus in Trauma.
I can be the first to write about it.
I just heard the good news.
You've got a nose for sniffing out zebras.
I wish I could take credit, but he landed it.
- Finders, keepers.
- Peter won't mind you scrubbing in.
- Give us a chance to work together.
- I think he might.
No.
No.
Of course not.
Great.
You both can run it.
I'll hang out on the sidelines in case I have to take one of you out.
Shall we scrub? So Don't you think it's time we called a truce? I am not at war.
I feel terrible.
I didn't mean to mislead you - about my family.
- It's not that big a deal, okay? - No hard feelings? - No.
Excuse me, John.
I hope I'm not interrupting.
- Henry! What are you doing here? - I wanna thank you for giving me time to finish my brain blots.
- Grab the end of that, please.
- The end? The results are so promising, I got a Howard Hughes Research Fellowship.
- Glad I could help.
- You did.
I was wondering if you might do me one more favor here.
- Favor, huh? - See, I'm not able to- Excuse me.
I can't start a new rotation until you remove these UEs from my evaluation.
So if you could just "Unable to evaluate physical examination.
Unable to evaluate technical and procedural skills.
Unable to evaluate interactions with the health care team.
" Yeah.
You can't just pass me? No.
You barely showed up.
Then the registrar says that I need to repeat this clerkship until I pass.
Anna, you don't have a student, do you? Don't need one.
Well, then, I guess it's just you and me.
Jeanie, I've been looking for you.
Well, you found me.
Good news.
Atlanta Memorial called.
They're very interested in you.
I faxed an excellent recommendation.
You should be a shoo-in for a position.
Thank you.
Jeanie, if there were any way I could change things, believe me, I would.
- I'm gonna miss you.
- I know.
There is no way we can take these people today.
Come back next week, they get priority.
You refuse to give the homeless physicals? I am not refusing.
We don't have any more appointments for today.
But I called two hours ago and a lady said that this was a walk-in clinic day.
Cynthia! Did you give permission to bring in these people? I figured it would be okay.
Are you a complete idiot? Can't you see we're swamped already? - I'm sorry.
- What's going on? She invited the entire Hazelton Shelter for free physicals.
Carol, can I talk to you? So there was miscommunication.
If you have a problem with Cynthia or any employee in the future speak to them privately.
Don't dress them down in front of the entire ER.
- Anything else? - No.
Liver's lacerated.
Excise the left lateral aspect.
- Which anatomically is the right lobe.
- Correct.
I don't know about you, but I'm getting dizzy.
- We should put a mirror on the ceiling.
- We could operate from my bedroom.
Get a photo from the other side.
Peter, expose the gallbladder.
- Found any family on this kid yet? - Not last I heard.
Get on it.
I wanna get releases for these photos.
Liver's still bleeding.
- You ever use an argon beam coagulator? - No.
Why don't I do the Pringle maneuver? Go for it.
My colleague would love to get some blood samples from this kid.
Suction, please.
All right.
Here we go.
All right.
Heads up.
Have Pathology pickle this.
Bet no one's ever seen a backwards liver.
- We can play "Stump the Med Students.
" - Not to mention publishing.
- We discussed that.
- Are you up for it? - I'm game.
- So am I.
Excellent.
We'll fight over whose name goes first on the papers later.
It's a wrist.
That's definitely a fracture of the wrist.
Yeah.
But there are eight bones in the wrist.
Which one? What are the odds of catching TB in this place? Henry, which bone is broken? - It's the lunate.
- No.
That's over here.
Here.
Remember this, would you? It's a mnemonic.
Never Lower Tillie's Pants.
Mother May Come Home.
Maybe you boys should talk privately.
No, I'm just teaching Henry the bones in the wrist.
Here.
"M" for "Mother" is the greater multangular.
You call that the multangular? I was taught it was the trapezium.
- Really? - I call that the scaphoid.
- What do you call it? - Navicular.
So my little mnemonic wouldn't work for you.
- That's okay.
I have my own.
- Really? Let's hear it.
Okay.
Scared Lovers Try Positions That They Can't Handle.
- Go with Anna's.
- He already learned yours.
I like yours better.
I don't think that I need either.
I'll just memorize the names.
Excuse me.
If Dr.
Anspaugh calls, tell him I'll have this budget in his hands today.
- Do you know who left this note? - No.
- "CH".
That's me.
- Dr.
Weaver? You drive a Plymouth? Your lights are on.
That's hard to believe.
Herb Spivak, snakebite to the upper left torso.
- Know what the venom is? - No.
It has feet like a piranha, and a head the size of a papaya.
Can you take this non-venomous snakebite to the left thorax? - I left my car lights on.
- Sure.
Curtain Area 3.
Can you sign off on this budget? Anspaugh's expecting it.
- Where? - Below my signature.
I'll be back.
How did this happen? I was feeding his python.
It bit me.
What do you expect? You spilled soup.
- Who are you? - Gary Lomax.
Owner of Jungle Gary's Reptorium.
- He spilled chicken soup on himself.
- What? Pythons love chicken, so I dipped the rat in my soup.
It spilled on my jacket.
Bingo! The guy got me.
Python thought he was the world's biggest chicken.
Ellis? Fancy meeting you here! Security said my lights were on.
A little ruse to get you out so I could thank you for getting us the contract.
- Anspaugh approved it? - Ink's still wet.
Synergix is now supplying extra Attending coverage to County General.
- All because of you.
- Why didn't you come into the hospital? I wanted to avoid suggestion of preferential treatment.
It's not preferential treatment.
It's good business.
We have that in common.
It's good business for me to say thanks.
- Thanks, Kerry.
- Phalaenopsis.
Ellis, you shouldn't have.
- You know phals? - I love them.
Something else we have in common.
Great job.
You really drained the hell out of that liver.
Once I got my bearings, it wasn't difficult.
I'm glad it came along.
Me too.
But a compass would've been helpful.
Check the crits and coags.
Make sure the Jackson Pratts don't clot off.
Catalog the photos and dig up every article you can find on situs inversus viscerum.
I'll watch the temp.
If it drops below 35, I'll use a warming blanket.
I'll alert the Genetics Department, if they want to consult.
Dr.
Romano, this is Mr.
Price.
Rodney's father.
The school called.
Told me there was an accident, to come right over.
How is my boy doing? We removed part of his liver to control the bleeding.
He's in serious condition but he came out of surgery well.
Aren't you Peter Benton? - From Collins High? - Yeah.
Isaac Price.
You two were classmates? Yeah.
Class of '83.
Peter was on that college track.
Nose to the grindstone.
It paid off.
Your son had an excellent surgeon.
Isaac, is your son on any medication or allergic to any drugs? I don't know.
He lives at his mother's.
Listen, is Rodney gonna be all right? You know, we're doing our best, man.
Damn it.
Damn it.
- Can I help? - No.
You've done plenty.
Thanks.
Carol, move your patients out of the Admit area.
We could get cited for blocking fire exits.
Dr.
Doyle, did you want your December meal tickets? - Who has time to eat? - I'll take them.
- They're for the residents.
- You heard.
Who has time to eat? You're going to need a tetanus booster, antibiotics.
And I'll have to extract those python teeth.
- Okay, doctor.
- Malik, can you get me some Betadine? I brought Flora along - in case you wanted to swab her.
- Flora? - She's actually quite gentle- - When she's not hungry.
How do you know? - She's harmless except for mouth rot.
- You think we should get a culture? I love her dearly.
But her mouth's a cesspool.
Malik you wanna give him a hand? I don't think so.
Just grab her middle.
Don't let go.
This next case of situs inversus apparently shows no cardiac involvement.
Dr.
Benton.
This is a great teaching case.
I discussed it with the residents and students.
Dr.
Benton and Dr.
Corday performed the surgery.
Photographs were taken.
Everybody would love to see them.
We need to change the patient's dressings.
No problem.
We'll come back later.
This is great work, Peter.
Don't forget those photos.
- Anspaugh's impressed.
- Yeah.
Here.
- How's the kid doing? - He's stable.
Here.
Lucky break, the father knowing you.
Should make it easier to consent him for blood tests.
Genetic breakthroughs are hovering in the winds.
You'll talk to the family? - Yeah.
- Yeah, great.
- Peter, is something wrong? - No.
- I'd be happy to talk to the father.
- Why? I thought it might be more comfortable since you know him.
I don't know him.
What difference would it make? It's tough if you have a personal connection.
I don't have a personal connection.
I don't want him to think we're using his kid.
We've treated him as best we can, haven't we? - Yeah.
- Then you've got nothing to worry about.
- Excuse me.
- My fault.
I'm not used to the floor plan.
- I don't think we've met.
I'm Jeanie.
- Yosh Takata.
New R.
N.
The new R.
N.
? How'd you get past the hiring freeze? I didn't know there was one.
I put in for a transfer to the ER.
- How long you been here? Do you like it? - Two years.
I do.
It's good to meet you.
I gotta run.
- How did you get these scars? - Defending a cave diver.
We got caught in a kelp forest.
Do you dive? - No.
- Oh, spectacular.
When did you start handling snakes? He's defending me in a lawsuit.
- Oh, you're an attorney.
- Yeah.
Flora ate his neighbor's Jack Russell terrier.
Obviously, they have no case whatsoever.
They're not recognized by the American Kennel Association.
Gary offered to help me work with snakes in exchange for legal counsel.
How could I refuse such an offer? Sure, Al.
I know.
I know.
Okay.
I love you too.
Bye.
- You okay? - Yeah.
Just Al.
Foreman job in Atlanta fell through.
I'm sorry.
Does he have other possibilities? Al always does.
Let me give you a hand.
- Thanks.
- How's it going for you? Lousy.
I don't know why I thought I could run a clinic with no supplies.
- I can't even write a scrip.
- P.
A.
's can write them.
But Kerry Weaver won't let me use any of the ER staff.
What's she gonna do? Fire me? Mark.
You are so romantic.
I am? Hiding that note under the charts.
My heart skipped a beat when I saw my initials.
- What? - On the envelope.
"CH"? What you wrote was really sexy.
- Did you mean it? - Yeah, sure.
Well, then my answer is yes.
I will.
Everything okay? Well, we just got some labs back.
Rodney's crit is okay.
But his platelets are falling.
We're concerned that his blood might not clot properly.
Is he gonna pull through? Well, he He may need to have a transfusion.
But don't worry.
I'll keep an eye on him.
Thanks, Peter.
I know you're doing everything you can, man.
All the doctors have been in, making sure he's all right.
Isaac, are you aware that Rodney has a rare genetic syndrome that caused his abdominal organs to be reversed? Is that why he's so sick? No.
But when he was hit by the car, his liver was severely injured.
See If it had been in the proper position, the prognosis might be better.
Listen, I I know it's not easy at times like this to ask, but we'd like permission to draw some of Rodney's blood along with yours and your ex-wife's to do a genetic study.
Yeah, okay.
I'll do anything if it'll help Rodney get better.
Here.
You need to sign the consent.
On a scale of one to 10, how would you rate your pain? Oh, I don't know.
When you push like that, it's a nine or an eight.
But it could be a six or a seven.
I'm not sure.
Ask him to describe the quality of the pain.
Mr.
Kottmeier, please describe the quality of your pain.
Quality? Is it dull? Is it sharp? Is it crampy? Is it constant? It's crampy, all right.
But sometimes it's sharp too.
When it's not dull.
I'm not sure.
I'm a double Libra.
You know how that is.
Not that I believe in horoscopes.
That appears sharp to me.
We're dealing with diverticulitis.
What do you wanna do? Well, that could be surgical or not.
Order an abdominal ultrasound or maybe get a CT.
I'm not sure.
Why don't we just start with a history and a physical? Can you write me a scrip for erythromycin ointment? I got a kid with conjunctivitis.
Having you here today has been a saving grace to me.
Thanks.
You worked hard to get this going.
I wish I had your guts.
You gotta fight for what you believe in.
What if you don't have the ammunition? Look for it.
- That won't hurt him, will it? - No.
Give me 5 units of platelets and FFP.
- Peter, what's wrong? - His blood's not clotting.
- What's going on? - Oh, my God! He went into DIC.
I'm bolusing 500 of heparin.
He's bradycardic.
Lungs are wet.
Put him on 100% oxygen.
His stats are falling! - Pulmonary hemorrhage.
- Get him on his stomach.
Here we go, people.
On my count.
One, two, three! What's happening here? His lungs are filling with blood.
- Jesus, please.
- Isaac, you gotta stand back.
You've gotta stand back, man.
Please.
He's in asystole! Amp of epi! We gotta get him turned back over.
Here we go.
On my count.
One, two, three, move! Gotta start CPR.
- Connie, have you seen Cynthia? - She's on a break.
- Do you know if she left her purse? - I don't know.
She really likes you.
Oh, yeah.
We're just having fun.
You gave her a diamond.
That's serious fun.
What are you doing? - Nothing.
I just lost my pen.
- Here.
- You sign off on the budget? - I found an error.
- Really? - Yeah.
Here it has your salary That's remuneration for my taking over administrative duties until Morgenstern returns, God willing.
$25,000 a year? You signed off on this three months ago.
Why didn't you say something? I guess I just wasn't paying attention.
Hey, Jeanie, have you seen a chart for Kottmeier? - No.
- Guess I'll start a new one.
And have you traveled anywhere recently? I just did.
Louisville, to visit the in-laws.
And then to Time to wrap up.
History and physical just took 90 minutes.
Shave an hour off, you'd be in passing range for this clerkship.
There's a rectal abscess in 2 with your name on it.
Mr.
Kottmeier, someone will see you shortly.
- It would've gone faster if my allergies- - Take an antihistamine.
Hi, Mr.
Kottmeier.
I'm Dr.
Del Amico.
I'm gonna examine you.
Boy, when they said shortly, they mean shortly! This new clinic's a godsend.
I work part-time.
No benefits.
So thank you.
No.
Thank you for saying that.
There you go, Hector.
That shot will keep you from getting sick.
If it's not too much trouble, could you look at his chin? He crabs about it, but I don't see anything wrong.
Sure.
Okay, Hector.
Does it hurt when I do this? I can't feel it.
- You don't feel me pressing on it? - No.
No? Okay, I'm gonna go see if I can find a doctor.
High-dose epi! Seven cc's, one to a thousand! Another mg of atropine! We got a blip! - Was it a pulse? - No pulse.
Maybe he's got fluid around the heart.
Pericardiocentesis needle.
Flatline.
An epi can cause a few transient heartbeats.
Damn! No blood.
All right.
Epi drip wide open and more platelets.
Let's go! Peter, it's been 20 minutes.
Peter! Peter.
Time of death, 4:52.
Get him up to CT.
Keep the C-collar on until Radiology clears the C-spine.
- You want films? - No.
The neurosurgeon will take them.
- Kerry, I'd like a minute with you.
- Sure.
Jeanie, what is it? I wanna take a look at the budget.
- The ER budget? - That's right.
Yeah.
I've told you.
It's nothing personal.
I tried everything to try and keep you here.
The numbers don't support it.
If I'm being fired, I wanna see the numbers not hear your interpretation of them.
I've gone over them with a fine-tooth comb.
It's not fair, but that's the way it is.
How do you justify hiring a new nurse? Yosh Takata was hired to replace two nurses who've left.
What about giving yourself a raise? Salaries are confidential.
I sure as hell know why.
- Jeanie, I'm sorry I can't help you.
- I'll find someone who can.
Hey, Carter.
Have you had a patient complain about his chin falling asleep? Heads up, Henry.
No.
I'm sure if it's contagious, he'll catch it.
- Where are you going? - Mr.
Kottmeier's my patient.
Then why did I do a physical on him? I'm quite fond of all of you.
You did remember to sign him out on the board, didn't you? - Was I supposed to? - Where are you taking him? To the surgical ward.
Mr.
Kottmeier has an inflamed diverticulum that perfed into his mesentery.
He needs a colectomy.
Hold on.
Have you considered medical management? Treat the abscess with a course of Flagyl and Cipro before jumping into surgery? - I'm willing to give it a shot.
- No, no, no, wait.
Do you agree because you think I wanna hear that? Or do you really believe that? What? I don't want you agreeing with me just to please me.
I'm not.
I've already considered several alternatives to surgery.
- You have? - Shut up, Henry! Mark.
If you have a problem with my salary, come to me.
Don't bring it up with the staff.
Do you have any idea how many hours I work every week? What are you talking about? - You disclosed our salaries to Jeanie.
- No, I didn't.
- You didn't? - No.
What happened to all the patients in your clinic? I gave them meal tickets and stashed them in the cafeteria.
Stressful day for you, huh? - Tell me about it.
- Anything interesting in Doug's note? I wish I knew.
- I lost it before I got to read it.
- That's too bad.
- How are you on Medline searches? - Why? I did one on submandibular paralysis and I came up with zilch.
I'm not surprised.
I've never heard of it.
I've got this kid complaining of a numb chin.
What should I do? Why don't you try "numb chin"? "Numb chin.
" That sounds a little too, you know, easy.
Hey.
There you go.
I'm sorry, Isaac.
Can we have a word with you in the hall? I don't wanna leave my boy.
We'd like your permission to perform an autopsy.
Why? Well, because it could be useful.
Did something go wrong? He started bleeding when you stuck him.
No.
His blood wouldn't clot because of the liver injury.
- Then why do you need to do an autopsy? - For research.
It could be helpful.
That's why you're so interested.
Not because he was hurt.
No, no, no.
We were trying to save his life.
When you took his blood and mine, were you trying to save his life? - No- - We'd like to study his condition.
I don't want him studied.
We understand how you- Look at him! Don't you think you cut him up enough? - Isaac, I'm so sorry.
- No! I don't want you cutting up my son! You're right.
I'm sorry.
I'll leave you alone.
Focus, Henry.
What do you hear? - I'm not- I'm not sure.
- What do you hear? He has a pneumothorax.
We'll put in a chest tube.
I'll grab a tray.
- It hurts.
- Yeah.
I bet it hurts.
Hang on there.
Everything will feel better in a minute.
Okay.
Henry, the first thing that you wanna do is feel for the ribs along the midaxillary line locating the fifth interspace.
Can I get some Betadine? Where you make the incision.
- I'm not feeling so good.
- What? I'm not feeling so good.
Sit down.
Put your head between your knees.
Lily, give me the Kelly.
How are you doing, Henry? Lydia, do me a favor and slide Henry out of the way.
- Carter, he's a little cyanotic.
- What? Can't get a pulse on the banger! Lydia, call an Attending! Change the dressing twice a day.
Think twice before defending any skydivers.
Thank you, doc.
We need you in Trauma 1.
Anna, Malik, we may need your help.
- What happened? - Banger had a tension pneumo.
- Henry passed out.
- All right.
I'll finish the chest tube.
Get your student into Trauma 2.
Okay.
Henry, you're gonna be just fine.
Everybody grab hold.
On my count.
One, two, three.
- What happened? - I don't know.
I showed him how to put in a chest tube and he fainted.
- Go on the other side.
- Wheezes bilaterally.
Pulse ox is 86.
I need to intubate.
Get me a laryngoscope.
- Let's go! - Did he complain of feeling sick? He always does.
He's a hypochondriac.
- Is he on any meds? - Not that I know of.
Okay.
Let's get a CBC, Chem-20, and a tox screen.
All right, I'm in.
- Bag him.
- Pulse ox is worse.
Down to 82.
What? Get a blood gas.
- Pressure's crashing! - What the hell is going on? His wrist and his left hand are red and edematous.
Right hand's also swollen.
Oh, my God! He's allergic to latex.
Okay.
He's in asystole! Amp of epi, IV push! ET tube cup has latex.
We've got to extubate.
Lily, get me an ET tube from the latex-free cart.
Wash your hands first.
Chuny, get me a basin of water.
- Found a non-latex ET tube.
- A mg of atropine and 50 of Benadryl! Laryngeal edema.
I'm having a hard time getting in.
- How long has he been down? -30 seconds.
- Watch his teeth.
Can you see the cords? - I know.
Barely.
All right, Malik.
Hi-dose epi.
Seven cc's.
You're doing great.
Just keep sliding it in very gently.
- I'm in.
- Great.
Good job.
Got a pulse.
Everything okay here? Everything's under control.
Peter, I'd like to speak to you.
I'd like to speak to you as well.
I've been reconsidering the possibility of joining your team.
I understand Mr.
Price refused an autopsy on his son.
Did you try to convince him? He doesn't want us carving his boy.
Did you explain how research might benefit others? He doesn't want it.
Give him some time.
He's emotional.
I don't feel comfortable doing that.
How do you think we made advances in heart surgery, in transplantation? By refining procedures on patients and studying the results.
That kid was a freak of nature.
And we have a responsibility to do research.
That "freak" was a boy named Rodney Price whose father doesn't understand why he lost him.
All you want to do is cut him despite his father's wishes.
We're scientists, Peter.
We're not allowed sentimentality.
Now, you go back and get consent.
- Because I want it.
- No.
You get somebody else to do it.
I just got a lab report back on one of my patients, a 7-year-old.
Turns out he's got acute lymphocytic leukemia.
A doctor should speak to the mother.
- How did it present? - Kid's complaint was a numb chin.
I checked in the computer, ran some tests.
The mom knows you.
Talk to her.
Call me if she has any questions.
And then I plea-bargained her down to a misdemeanor not two weeks after she shot a guy! You could've saved yourself a whole bunch of urgent phone messages if you'd told me Herb was on board.
- I didn't know you knew each other.
- Yeah.
I served on the Trial Lawyers' Banquet Committee.
Herb was our speaker.
I've been filling him in on that Law family suit.
You got yourself quite a little mess.
I've decided to ignore the whole thing.
Oh, wrong impulse.
You'll get slaughtered.
You had better file this right away to avoid a summary judgment.
Mark, the hospital's board of directors is gonna be very relieved to hear that you have such excellent representation.
You know, you came about this close to losing your job.
Herb, if you have any questions at all, please just give me a call.
I shall.
I shall.
- Take care of yourself, Alan.
- You too.
Mark.
Why did you let Alan believe that you're representing me? Honestly, doc, he's a lousy lawyer.
He jumps to conclusions.
Nevertheless, I could represent you.
Your fee would be a little too steep for me.
$10,000 retainer fee.
- I figured.
- But, honestly, I don't need the money.
I'm bored.
I'm looking for new challenges.
Here's the deal.
Let me shadow you.
You throw in a few procedures.
Nothing big.
Maybe a couple of stitches here and there.
And I'll make your little lawsuit vanish just like that.
Gratis.
I got an autopsy consent on the Price boy.
The father just needed more time.
Why didn't Rocket send you? I refused.
That was a ballsy move.
It wasn't a move.
I told him what I felt.
Well, it worked.
Take a look at tomorrow's surgery schedule.
You're scrubbing in on a lap splenectomy at 7 a.
m.
Rocket's team.
He's partial to residents with backbone.
John? Yes, Henry? What happened? You went into anaphylactic shock from latex.
I was near death.
- Yes.
- And you were there.
Yes, Henry.
I was there.
And so was Anna.
It was like a dream.
Anna! Hey, Henry.
It was the most amazing thing.
I remember being drawn toward this bright light.
And then suddenly I was floating up above you over there in the corner watching as the two of you enveloped in a blue glow worked together, united to save my life.
Thank you, John.
Thank you, Anna.
You are my angels.
You brought me back to the living.
Good night.
Good night.
Can't be a chart you're writing.
No.
And from the way you're covering it up I'd say it's something personal.
Yeah.
It's a It's a love letter.
The sentimental kind or the "I'd like to rip your pants off" kind? Definitely the latter.
I'd like to be writing one of those.
Pity I broke up with Jeremy.
- Could've been more fun, long-distance.
- Someone from home? A self-possessed dermatologist.
I'm afraid I broke his heart.
Well, it's 9:00.
And since you're writing rather than living out your prose - I'd venture to say you're alone.
- Yeah.
Fancy grabbing a drink? I would love to.
It is an unenviable job running the ER and making difficult cost-cutting decisions.
I got your message.
Jeanie came in quite upset about the budget.
And I was just explaining that it appears that you treated her honestly and fairly.
She gave herself a $25,000 raise.
That's from the administrative budget.
I understand that's your story.
But I don't buy it.
Something else is going on.
And what would that be? My HIV status.
Jeanie! I believe that's why I'm being fired.
I see.
Well Let's not do anything rash.
I am late for a dinner at the moment.
But tomorrow I can give the budget another more thorough review.
We've been over these figures a dozen times.
You told me we had to cut P.
A.
s.
Why don't you give Kerry and me another day to recheck our figures? Thank you, Dr.
Anspaugh.
I will.
Jeanie, you're really gonna use your HIV status like this? I call it as I see it.
I tried everything to keep you here.
Then I bent over backwards to help you get a job in Atlanta.
It just isn't fair, is it? I've never discriminated against you because of your HIV status.
I fought to keep you here.
Kerry, like you said before, it's nothing personal.
- To your health! - Thank you.
Here.
- What have we here? - What have we here? Another present? It's beautiful.
Should I try it on? You can try it on later.
I dream of the taste of your neck and the smell of your hair on my pillow.
You do? No, silly.
You do.
Did you mean everything you wrote? Yeah.
Yeah, I did.
It was I was homesick.
Do you remember this afternoon when I said that I will? I changed my mind.
I won't.
You won't? Not unless you go first.
Lie back.
Oh, jeez! Your clinic proposal.
That's tonight, isn't it? Yeah, Oak Park, 7:00.
That's what we said.
Your husband lied to you about his condition! He's going to die! Peter Benton, Rocket Romano.
Dr.
Benton.
Hey, Lizzie's talked about you.
I don't usually do this kind of thing.
Sure.
That's what they all say.
My family has a few bucks and everything changes? A few bucks? Is that what it is to you? Freak Show Carol! Man, look at you! I hardly sleep a wink on the redeye and you're jogging and smiling.
There's nothing like a visit with the folks to make you appreciate home.
The staff will be thrilled.
You haven't been too high on the popularity list lately.
- I've been kind of a jerk.
- Worse.
- Pain in the ass? - Keep going.
- Total schmuck.
- Bingo.
We all understood.
It's just we're glad you're getting over it.
You know, that meant a lot to Doug, you showing up like that.
It meant a lot to me too.
I almost forgot.
I found this when I unpacked.
- "CH"? - Yeah.
"Carol Hathaway.
" It's from "DR.
" - Did you read it? - No.
But I was tempted.
Anna? Can you come in here and give me a hand? - What have you got? - A shoulder reduction on a boxer.
Coach made him take ballet.
I'll do traction.
Then I will give you countertraction.
Thanks, Lily.
- So how have you been? - Fine.
On my count.
One, two, three.
- Seen any interesting cases? - No.
Not really.
- Done any interesting procedures? - Nope.
- You wanna grab some breakfast? - I'm not hungry.
Thanks.
- What? Are you still angry? - I'm over it.
You sure? Can we just focus on the patient, please? - Hey! Cute little bugger.
- Thanks.
I bet he keeps you pretty busy.
Actually, he lives with his mother.
So I see him when I can.
What about you? You got any kids? None they've been able to pin on me.
You know, Peter, you've been on my mind lately.
You made the short list for my team.
You still interested? Sure.
- I just have a couple of reservations.
- Reservations? Yeah.
I need a team player.
Someone who is compatible with Lizzie Corday.
Now, word has it you and she have had a couple of run-ins.
We've had our differences, but we've worked them out.
Differences can be healthy.
Can you keep up with her? Absolutely.
Do you have the time? Sure.
Great.
We'll do a trial run, see if we're all compatible.
And then I'll make my final decision.
What's going on? Mark, when did you get back? Hi.
Late last night.
- What are these people doing here? - They're patients for your new clinic.
No.
The clinic doesn't open until next week.
You said to put the announcement in for today.
No.
I said next week.
Oh, man! Oh, I'm really sorry.
Is there anything that I can do? Start giving out numbers.
Hey, everybody, listen up.
I need volunteers to come back next week.
You'll get on the front of the line.
No? Then everyone has to be really patient.
Tell that to my boss.
- Bryan, baby.
- Oh, miss I can't keep standing like this.
I've got the gout.
Take a chair.
Anyone else need a chair? Stop jumping up and down.
Wait over in Chairs.
Take a number.
Twenty-seven? I might as well be waiting six hours in the ER.
Go ahead.
That would help me out a lot.
Carol? Kerry, hi.
Did Mark tell you about the scheduling snafu? Very unfortunate.
I need to talk with you.
I'm a little busy now.
Weren't you scheduled to work the ER? I had to take the day off to run the clinic.
- Could you spare anyone to help? - When I signed off on the clinic you promised to find your own personnel and it wouldn't impinge on your regular duties.
I could turf the runny noses, BP checks over to the ER and have your personnel handle them.
- Okay.
I'll give you Yosh Takata.
- Who? Nursing Administration.
Excuse me.
Transfer from upstairs.
Why don't you talk to my friend at the Gay and Lesbian Defense Fund? They represent people with HIV and AIDS who have been fired.
Maggie, thanks for your concern, but that's not what happened.
Sure.
You're the best P.
A.
we have.
I just hate to see you give up.
I'm not giving up.
I'm moving on.
Al's in Atlanta checking out leads and a couple of construction jobs.
But it's illegal for them to fire you for being HIV-positive.
- You think that's why they fired me? - You don't? No.
They could've done that last year.
It's because of the budget.
- Hi.
- Hi.
- I missed you.
- Me too.
You did? Because you didn't call.
Well, we were on the road the whole time but So I wasn't able to wrap it.
What's this? Oh, it's beautiful! Thank you! I love it! Oh, my-! Would you latch it for me? Sure.
The guy at the shop said that it is a genuine diamond.
A real diamond.
No one has ever gotten me a real diamond before, Mark.
I love it.
- Pardon us.
- Welcome back.
There's no place like home.
This coffee's terrible.
I'm really awful in the kitchen.
Sorry.
I think it tastes really good.
- What do we got? - Twelve-year-old boy.
Hit-and-run on his way to school.
GCS 7.
Got routine blood work.
Chest and abdominal films, C-spine.
BP's funky, 80 palp.
Gave him two units O-neg.
The name on this notebook says Rodney Price.
There's a mass in the upper left quadrant.
Abdomen is distended.
Crit's falling, 26.
Bleeding internally.
I'll hang another unit on the rapid infuser.
- He ruptured his spleen.
- Biggest spleen I've ever felt.
- Got the wet reads.
- Great.
Here's the shadow.
That's the hematoma pressing down on the splenic flexure.
- Looks like a rupture.
- No, no.
Wait a minute.
Wait a minute.
The film's mislabeled.
The gastric bubble is under the right diaphragm instead of the left.
But with a splenic rupture, the gastric bubble can be displaced.
No, no, no.
Not that much it can't Whoa, whoa, wait a minute! That's not his spleen.
That's his liver.
The liver's in the wrong place.
- Backwards? - His abdominal organs are reversed.
That's remarkable.
Let's get him up to Surgery! Move! Ever do a case like this before? No.
This is one in a million.
All right, everybody.
Page Romano! - You have previous clinic experience? - A little.
- Where would that have been? - Chart Review.
You don't see many patients in Chart Review.
No.
But I know a lot about them.
We'll have to double up on patients in here.
- Be with you in a minute.
- You said that an hour ago.
Sign in patients, start a chart, and check their vitals.
- Where? - Out here.
If anyone seems the least bit emergent, take them over to ER Triage.
Can you handle that? - If I have any questions, I'll holler.
- Great.
Mark! Oh, bring the kid out here, please.
- Do you have a sec? - I gotta get to Radiology.
But I got a triple failure otitis media that needs a scrip for Augmentin.
All right.
How's it going, Carol? You know, I would've been organized by next week.
You couldn't help me at all today? Well, it's a little busy not having Doug here.
- But I'll see what I can do.
- All right.
I appreciate it.
- I think Carol's mad at me.
- No.
She's just got a lot on her mind.
That hospital lawyer dropped off these papers for you to sign.
They're urgent, about the civil rights case.
- File them in my box.
- Along with the others? Yeah.
I'm not gonna let these bastards get to me.
The man of the hour's arrived.
- This is the situs inversus? - It sure is.
Fantastic case, Peter.
I've never seen one in the flesh before.
It's worth considering a case report.
I'm actually thinking of running a literature review.
I took the liberty.
There's nothing on abdominal situs inversus in Trauma.
I can be the first to write about it.
I just heard the good news.
You've got a nose for sniffing out zebras.
I wish I could take credit, but he landed it.
- Finders, keepers.
- Peter won't mind you scrubbing in.
- Give us a chance to work together.
- I think he might.
No.
No.
Of course not.
Great.
You both can run it.
I'll hang out on the sidelines in case I have to take one of you out.
Shall we scrub? So Don't you think it's time we called a truce? I am not at war.
I feel terrible.
I didn't mean to mislead you - about my family.
- It's not that big a deal, okay? - No hard feelings? - No.
Excuse me, John.
I hope I'm not interrupting.
- Henry! What are you doing here? - I wanna thank you for giving me time to finish my brain blots.
- Grab the end of that, please.
- The end? The results are so promising, I got a Howard Hughes Research Fellowship.
- Glad I could help.
- You did.
I was wondering if you might do me one more favor here.
- Favor, huh? - See, I'm not able to- Excuse me.
I can't start a new rotation until you remove these UEs from my evaluation.
So if you could just "Unable to evaluate physical examination.
Unable to evaluate technical and procedural skills.
Unable to evaluate interactions with the health care team.
" Yeah.
You can't just pass me? No.
You barely showed up.
Then the registrar says that I need to repeat this clerkship until I pass.
Anna, you don't have a student, do you? Don't need one.
Well, then, I guess it's just you and me.
Jeanie, I've been looking for you.
Well, you found me.
Good news.
Atlanta Memorial called.
They're very interested in you.
I faxed an excellent recommendation.
You should be a shoo-in for a position.
Thank you.
Jeanie, if there were any way I could change things, believe me, I would.
- I'm gonna miss you.
- I know.
There is no way we can take these people today.
Come back next week, they get priority.
You refuse to give the homeless physicals? I am not refusing.
We don't have any more appointments for today.
But I called two hours ago and a lady said that this was a walk-in clinic day.
Cynthia! Did you give permission to bring in these people? I figured it would be okay.
Are you a complete idiot? Can't you see we're swamped already? - I'm sorry.
- What's going on? She invited the entire Hazelton Shelter for free physicals.
Carol, can I talk to you? So there was miscommunication.
If you have a problem with Cynthia or any employee in the future speak to them privately.
Don't dress them down in front of the entire ER.
- Anything else? - No.
Liver's lacerated.
Excise the left lateral aspect.
- Which anatomically is the right lobe.
- Correct.
I don't know about you, but I'm getting dizzy.
- We should put a mirror on the ceiling.
- We could operate from my bedroom.
Get a photo from the other side.
Peter, expose the gallbladder.
- Found any family on this kid yet? - Not last I heard.
Get on it.
I wanna get releases for these photos.
Liver's still bleeding.
- You ever use an argon beam coagulator? - No.
Why don't I do the Pringle maneuver? Go for it.
My colleague would love to get some blood samples from this kid.
Suction, please.
All right.
Here we go.
All right.
Heads up.
Have Pathology pickle this.
Bet no one's ever seen a backwards liver.
- We can play "Stump the Med Students.
" - Not to mention publishing.
- We discussed that.
- Are you up for it? - I'm game.
- So am I.
Excellent.
We'll fight over whose name goes first on the papers later.
It's a wrist.
That's definitely a fracture of the wrist.
Yeah.
But there are eight bones in the wrist.
Which one? What are the odds of catching TB in this place? Henry, which bone is broken? - It's the lunate.
- No.
That's over here.
Here.
Remember this, would you? It's a mnemonic.
Never Lower Tillie's Pants.
Mother May Come Home.
Maybe you boys should talk privately.
No, I'm just teaching Henry the bones in the wrist.
Here.
"M" for "Mother" is the greater multangular.
You call that the multangular? I was taught it was the trapezium.
- Really? - I call that the scaphoid.
- What do you call it? - Navicular.
So my little mnemonic wouldn't work for you.
- That's okay.
I have my own.
- Really? Let's hear it.
Okay.
Scared Lovers Try Positions That They Can't Handle.
- Go with Anna's.
- He already learned yours.
I like yours better.
I don't think that I need either.
I'll just memorize the names.
Excuse me.
If Dr.
Anspaugh calls, tell him I'll have this budget in his hands today.
- Do you know who left this note? - No.
- "CH".
That's me.
- Dr.
Weaver? You drive a Plymouth? Your lights are on.
That's hard to believe.
Herb Spivak, snakebite to the upper left torso.
- Know what the venom is? - No.
It has feet like a piranha, and a head the size of a papaya.
Can you take this non-venomous snakebite to the left thorax? - I left my car lights on.
- Sure.
Curtain Area 3.
Can you sign off on this budget? Anspaugh's expecting it.
- Where? - Below my signature.
I'll be back.
How did this happen? I was feeding his python.
It bit me.
What do you expect? You spilled soup.
- Who are you? - Gary Lomax.
Owner of Jungle Gary's Reptorium.
- He spilled chicken soup on himself.
- What? Pythons love chicken, so I dipped the rat in my soup.
It spilled on my jacket.
Bingo! The guy got me.
Python thought he was the world's biggest chicken.
Ellis? Fancy meeting you here! Security said my lights were on.
A little ruse to get you out so I could thank you for getting us the contract.
- Anspaugh approved it? - Ink's still wet.
Synergix is now supplying extra Attending coverage to County General.
- All because of you.
- Why didn't you come into the hospital? I wanted to avoid suggestion of preferential treatment.
It's not preferential treatment.
It's good business.
We have that in common.
It's good business for me to say thanks.
- Thanks, Kerry.
- Phalaenopsis.
Ellis, you shouldn't have.
- You know phals? - I love them.
Something else we have in common.
Great job.
You really drained the hell out of that liver.
Once I got my bearings, it wasn't difficult.
I'm glad it came along.
Me too.
But a compass would've been helpful.
Check the crits and coags.
Make sure the Jackson Pratts don't clot off.
Catalog the photos and dig up every article you can find on situs inversus viscerum.
I'll watch the temp.
If it drops below 35, I'll use a warming blanket.
I'll alert the Genetics Department, if they want to consult.
Dr.
Romano, this is Mr.
Price.
Rodney's father.
The school called.
Told me there was an accident, to come right over.
How is my boy doing? We removed part of his liver to control the bleeding.
He's in serious condition but he came out of surgery well.
Aren't you Peter Benton? - From Collins High? - Yeah.
Isaac Price.
You two were classmates? Yeah.
Class of '83.
Peter was on that college track.
Nose to the grindstone.
It paid off.
Your son had an excellent surgeon.
Isaac, is your son on any medication or allergic to any drugs? I don't know.
He lives at his mother's.
Listen, is Rodney gonna be all right? You know, we're doing our best, man.
Damn it.
Damn it.
- Can I help? - No.
You've done plenty.
Thanks.
Carol, move your patients out of the Admit area.
We could get cited for blocking fire exits.
Dr.
Doyle, did you want your December meal tickets? - Who has time to eat? - I'll take them.
- They're for the residents.
- You heard.
Who has time to eat? You're going to need a tetanus booster, antibiotics.
And I'll have to extract those python teeth.
- Okay, doctor.
- Malik, can you get me some Betadine? I brought Flora along - in case you wanted to swab her.
- Flora? - She's actually quite gentle- - When she's not hungry.
How do you know? - She's harmless except for mouth rot.
- You think we should get a culture? I love her dearly.
But her mouth's a cesspool.
Malik you wanna give him a hand? I don't think so.
Just grab her middle.
Don't let go.
This next case of situs inversus apparently shows no cardiac involvement.
Dr.
Benton.
This is a great teaching case.
I discussed it with the residents and students.
Dr.
Benton and Dr.
Corday performed the surgery.
Photographs were taken.
Everybody would love to see them.
We need to change the patient's dressings.
No problem.
We'll come back later.
This is great work, Peter.
Don't forget those photos.
- Anspaugh's impressed.
- Yeah.
Here.
- How's the kid doing? - He's stable.
Here.
Lucky break, the father knowing you.
Should make it easier to consent him for blood tests.
Genetic breakthroughs are hovering in the winds.
You'll talk to the family? - Yeah.
- Yeah, great.
- Peter, is something wrong? - No.
- I'd be happy to talk to the father.
- Why? I thought it might be more comfortable since you know him.
I don't know him.
What difference would it make? It's tough if you have a personal connection.
I don't have a personal connection.
I don't want him to think we're using his kid.
We've treated him as best we can, haven't we? - Yeah.
- Then you've got nothing to worry about.
- Excuse me.
- My fault.
I'm not used to the floor plan.
- I don't think we've met.
I'm Jeanie.
- Yosh Takata.
New R.
N.
The new R.
N.
? How'd you get past the hiring freeze? I didn't know there was one.
I put in for a transfer to the ER.
- How long you been here? Do you like it? - Two years.
I do.
It's good to meet you.
I gotta run.
- How did you get these scars? - Defending a cave diver.
We got caught in a kelp forest.
Do you dive? - No.
- Oh, spectacular.
When did you start handling snakes? He's defending me in a lawsuit.
- Oh, you're an attorney.
- Yeah.
Flora ate his neighbor's Jack Russell terrier.
Obviously, they have no case whatsoever.
They're not recognized by the American Kennel Association.
Gary offered to help me work with snakes in exchange for legal counsel.
How could I refuse such an offer? Sure, Al.
I know.
I know.
Okay.
I love you too.
Bye.
- You okay? - Yeah.
Just Al.
Foreman job in Atlanta fell through.
I'm sorry.
Does he have other possibilities? Al always does.
Let me give you a hand.
- Thanks.
- How's it going for you? Lousy.
I don't know why I thought I could run a clinic with no supplies.
- I can't even write a scrip.
- P.
A.
's can write them.
But Kerry Weaver won't let me use any of the ER staff.
What's she gonna do? Fire me? Mark.
You are so romantic.
I am? Hiding that note under the charts.
My heart skipped a beat when I saw my initials.
- What? - On the envelope.
"CH"? What you wrote was really sexy.
- Did you mean it? - Yeah, sure.
Well, then my answer is yes.
I will.
Everything okay? Well, we just got some labs back.
Rodney's crit is okay.
But his platelets are falling.
We're concerned that his blood might not clot properly.
Is he gonna pull through? Well, he He may need to have a transfusion.
But don't worry.
I'll keep an eye on him.
Thanks, Peter.
I know you're doing everything you can, man.
All the doctors have been in, making sure he's all right.
Isaac, are you aware that Rodney has a rare genetic syndrome that caused his abdominal organs to be reversed? Is that why he's so sick? No.
But when he was hit by the car, his liver was severely injured.
See If it had been in the proper position, the prognosis might be better.
Listen, I I know it's not easy at times like this to ask, but we'd like permission to draw some of Rodney's blood along with yours and your ex-wife's to do a genetic study.
Yeah, okay.
I'll do anything if it'll help Rodney get better.
Here.
You need to sign the consent.
On a scale of one to 10, how would you rate your pain? Oh, I don't know.
When you push like that, it's a nine or an eight.
But it could be a six or a seven.
I'm not sure.
Ask him to describe the quality of the pain.
Mr.
Kottmeier, please describe the quality of your pain.
Quality? Is it dull? Is it sharp? Is it crampy? Is it constant? It's crampy, all right.
But sometimes it's sharp too.
When it's not dull.
I'm not sure.
I'm a double Libra.
You know how that is.
Not that I believe in horoscopes.
That appears sharp to me.
We're dealing with diverticulitis.
What do you wanna do? Well, that could be surgical or not.
Order an abdominal ultrasound or maybe get a CT.
I'm not sure.
Why don't we just start with a history and a physical? Can you write me a scrip for erythromycin ointment? I got a kid with conjunctivitis.
Having you here today has been a saving grace to me.
Thanks.
You worked hard to get this going.
I wish I had your guts.
You gotta fight for what you believe in.
What if you don't have the ammunition? Look for it.
- That won't hurt him, will it? - No.
Give me 5 units of platelets and FFP.
- Peter, what's wrong? - His blood's not clotting.
- What's going on? - Oh, my God! He went into DIC.
I'm bolusing 500 of heparin.
He's bradycardic.
Lungs are wet.
Put him on 100% oxygen.
His stats are falling! - Pulmonary hemorrhage.
- Get him on his stomach.
Here we go, people.
On my count.
One, two, three! What's happening here? His lungs are filling with blood.
- Jesus, please.
- Isaac, you gotta stand back.
You've gotta stand back, man.
Please.
He's in asystole! Amp of epi! We gotta get him turned back over.
Here we go.
On my count.
One, two, three, move! Gotta start CPR.
- Connie, have you seen Cynthia? - She's on a break.
- Do you know if she left her purse? - I don't know.
She really likes you.
Oh, yeah.
We're just having fun.
You gave her a diamond.
That's serious fun.
What are you doing? - Nothing.
I just lost my pen.
- Here.
- You sign off on the budget? - I found an error.
- Really? - Yeah.
Here it has your salary That's remuneration for my taking over administrative duties until Morgenstern returns, God willing.
$25,000 a year? You signed off on this three months ago.
Why didn't you say something? I guess I just wasn't paying attention.
Hey, Jeanie, have you seen a chart for Kottmeier? - No.
- Guess I'll start a new one.
And have you traveled anywhere recently? I just did.
Louisville, to visit the in-laws.
And then to Time to wrap up.
History and physical just took 90 minutes.
Shave an hour off, you'd be in passing range for this clerkship.
There's a rectal abscess in 2 with your name on it.
Mr.
Kottmeier, someone will see you shortly.
- It would've gone faster if my allergies- - Take an antihistamine.
Hi, Mr.
Kottmeier.
I'm Dr.
Del Amico.
I'm gonna examine you.
Boy, when they said shortly, they mean shortly! This new clinic's a godsend.
I work part-time.
No benefits.
So thank you.
No.
Thank you for saying that.
There you go, Hector.
That shot will keep you from getting sick.
If it's not too much trouble, could you look at his chin? He crabs about it, but I don't see anything wrong.
Sure.
Okay, Hector.
Does it hurt when I do this? I can't feel it.
- You don't feel me pressing on it? - No.
No? Okay, I'm gonna go see if I can find a doctor.
High-dose epi! Seven cc's, one to a thousand! Another mg of atropine! We got a blip! - Was it a pulse? - No pulse.
Maybe he's got fluid around the heart.
Pericardiocentesis needle.
Flatline.
An epi can cause a few transient heartbeats.
Damn! No blood.
All right.
Epi drip wide open and more platelets.
Let's go! Peter, it's been 20 minutes.
Peter! Peter.
Time of death, 4:52.
Get him up to CT.
Keep the C-collar on until Radiology clears the C-spine.
- You want films? - No.
The neurosurgeon will take them.
- Kerry, I'd like a minute with you.
- Sure.
Jeanie, what is it? I wanna take a look at the budget.
- The ER budget? - That's right.
Yeah.
I've told you.
It's nothing personal.
I tried everything to try and keep you here.
The numbers don't support it.
If I'm being fired, I wanna see the numbers not hear your interpretation of them.
I've gone over them with a fine-tooth comb.
It's not fair, but that's the way it is.
How do you justify hiring a new nurse? Yosh Takata was hired to replace two nurses who've left.
What about giving yourself a raise? Salaries are confidential.
I sure as hell know why.
- Jeanie, I'm sorry I can't help you.
- I'll find someone who can.
Hey, Carter.
Have you had a patient complain about his chin falling asleep? Heads up, Henry.
No.
I'm sure if it's contagious, he'll catch it.
- Where are you going? - Mr.
Kottmeier's my patient.
Then why did I do a physical on him? I'm quite fond of all of you.
You did remember to sign him out on the board, didn't you? - Was I supposed to? - Where are you taking him? To the surgical ward.
Mr.
Kottmeier has an inflamed diverticulum that perfed into his mesentery.
He needs a colectomy.
Hold on.
Have you considered medical management? Treat the abscess with a course of Flagyl and Cipro before jumping into surgery? - I'm willing to give it a shot.
- No, no, no, wait.
Do you agree because you think I wanna hear that? Or do you really believe that? What? I don't want you agreeing with me just to please me.
I'm not.
I've already considered several alternatives to surgery.
- You have? - Shut up, Henry! Mark.
If you have a problem with my salary, come to me.
Don't bring it up with the staff.
Do you have any idea how many hours I work every week? What are you talking about? - You disclosed our salaries to Jeanie.
- No, I didn't.
- You didn't? - No.
What happened to all the patients in your clinic? I gave them meal tickets and stashed them in the cafeteria.
Stressful day for you, huh? - Tell me about it.
- Anything interesting in Doug's note? I wish I knew.
- I lost it before I got to read it.
- That's too bad.
- How are you on Medline searches? - Why? I did one on submandibular paralysis and I came up with zilch.
I'm not surprised.
I've never heard of it.
I've got this kid complaining of a numb chin.
What should I do? Why don't you try "numb chin"? "Numb chin.
" That sounds a little too, you know, easy.
Hey.
There you go.
I'm sorry, Isaac.
Can we have a word with you in the hall? I don't wanna leave my boy.
We'd like your permission to perform an autopsy.
Why? Well, because it could be useful.
Did something go wrong? He started bleeding when you stuck him.
No.
His blood wouldn't clot because of the liver injury.
- Then why do you need to do an autopsy? - For research.
It could be helpful.
That's why you're so interested.
Not because he was hurt.
No, no, no.
We were trying to save his life.
When you took his blood and mine, were you trying to save his life? - No- - We'd like to study his condition.
I don't want him studied.
We understand how you- Look at him! Don't you think you cut him up enough? - Isaac, I'm so sorry.
- No! I don't want you cutting up my son! You're right.
I'm sorry.
I'll leave you alone.
Focus, Henry.
What do you hear? - I'm not- I'm not sure.
- What do you hear? He has a pneumothorax.
We'll put in a chest tube.
I'll grab a tray.
- It hurts.
- Yeah.
I bet it hurts.
Hang on there.
Everything will feel better in a minute.
Okay.
Henry, the first thing that you wanna do is feel for the ribs along the midaxillary line locating the fifth interspace.
Can I get some Betadine? Where you make the incision.
- I'm not feeling so good.
- What? I'm not feeling so good.
Sit down.
Put your head between your knees.
Lily, give me the Kelly.
How are you doing, Henry? Lydia, do me a favor and slide Henry out of the way.
- Carter, he's a little cyanotic.
- What? Can't get a pulse on the banger! Lydia, call an Attending! Change the dressing twice a day.
Think twice before defending any skydivers.
Thank you, doc.
We need you in Trauma 1.
Anna, Malik, we may need your help.
- What happened? - Banger had a tension pneumo.
- Henry passed out.
- All right.
I'll finish the chest tube.
Get your student into Trauma 2.
Okay.
Henry, you're gonna be just fine.
Everybody grab hold.
On my count.
One, two, three.
- What happened? - I don't know.
I showed him how to put in a chest tube and he fainted.
- Go on the other side.
- Wheezes bilaterally.
Pulse ox is 86.
I need to intubate.
Get me a laryngoscope.
- Let's go! - Did he complain of feeling sick? He always does.
He's a hypochondriac.
- Is he on any meds? - Not that I know of.
Okay.
Let's get a CBC, Chem-20, and a tox screen.
All right, I'm in.
- Bag him.
- Pulse ox is worse.
Down to 82.
What? Get a blood gas.
- Pressure's crashing! - What the hell is going on? His wrist and his left hand are red and edematous.
Right hand's also swollen.
Oh, my God! He's allergic to latex.
Okay.
He's in asystole! Amp of epi, IV push! ET tube cup has latex.
We've got to extubate.
Lily, get me an ET tube from the latex-free cart.
Wash your hands first.
Chuny, get me a basin of water.
- Found a non-latex ET tube.
- A mg of atropine and 50 of Benadryl! Laryngeal edema.
I'm having a hard time getting in.
- How long has he been down? -30 seconds.
- Watch his teeth.
Can you see the cords? - I know.
Barely.
All right, Malik.
Hi-dose epi.
Seven cc's.
You're doing great.
Just keep sliding it in very gently.
- I'm in.
- Great.
Good job.
Got a pulse.
Everything okay here? Everything's under control.
Peter, I'd like to speak to you.
I'd like to speak to you as well.
I've been reconsidering the possibility of joining your team.
I understand Mr.
Price refused an autopsy on his son.
Did you try to convince him? He doesn't want us carving his boy.
Did you explain how research might benefit others? He doesn't want it.
Give him some time.
He's emotional.
I don't feel comfortable doing that.
How do you think we made advances in heart surgery, in transplantation? By refining procedures on patients and studying the results.
That kid was a freak of nature.
And we have a responsibility to do research.
That "freak" was a boy named Rodney Price whose father doesn't understand why he lost him.
All you want to do is cut him despite his father's wishes.
We're scientists, Peter.
We're not allowed sentimentality.
Now, you go back and get consent.
- Because I want it.
- No.
You get somebody else to do it.
I just got a lab report back on one of my patients, a 7-year-old.
Turns out he's got acute lymphocytic leukemia.
A doctor should speak to the mother.
- How did it present? - Kid's complaint was a numb chin.
I checked in the computer, ran some tests.
The mom knows you.
Talk to her.
Call me if she has any questions.
And then I plea-bargained her down to a misdemeanor not two weeks after she shot a guy! You could've saved yourself a whole bunch of urgent phone messages if you'd told me Herb was on board.
- I didn't know you knew each other.
- Yeah.
I served on the Trial Lawyers' Banquet Committee.
Herb was our speaker.
I've been filling him in on that Law family suit.
You got yourself quite a little mess.
I've decided to ignore the whole thing.
Oh, wrong impulse.
You'll get slaughtered.
You had better file this right away to avoid a summary judgment.
Mark, the hospital's board of directors is gonna be very relieved to hear that you have such excellent representation.
You know, you came about this close to losing your job.
Herb, if you have any questions at all, please just give me a call.
I shall.
I shall.
- Take care of yourself, Alan.
- You too.
Mark.
Why did you let Alan believe that you're representing me? Honestly, doc, he's a lousy lawyer.
He jumps to conclusions.
Nevertheless, I could represent you.
Your fee would be a little too steep for me.
$10,000 retainer fee.
- I figured.
- But, honestly, I don't need the money.
I'm bored.
I'm looking for new challenges.
Here's the deal.
Let me shadow you.
You throw in a few procedures.
Nothing big.
Maybe a couple of stitches here and there.
And I'll make your little lawsuit vanish just like that.
Gratis.
I got an autopsy consent on the Price boy.
The father just needed more time.
Why didn't Rocket send you? I refused.
That was a ballsy move.
It wasn't a move.
I told him what I felt.
Well, it worked.
Take a look at tomorrow's surgery schedule.
You're scrubbing in on a lap splenectomy at 7 a.
m.
Rocket's team.
He's partial to residents with backbone.
John? Yes, Henry? What happened? You went into anaphylactic shock from latex.
I was near death.
- Yes.
- And you were there.
Yes, Henry.
I was there.
And so was Anna.
It was like a dream.
Anna! Hey, Henry.
It was the most amazing thing.
I remember being drawn toward this bright light.
And then suddenly I was floating up above you over there in the corner watching as the two of you enveloped in a blue glow worked together, united to save my life.
Thank you, John.
Thank you, Anna.
You are my angels.
You brought me back to the living.
Good night.
Good night.
Can't be a chart you're writing.
No.
And from the way you're covering it up I'd say it's something personal.
Yeah.
It's a It's a love letter.
The sentimental kind or the "I'd like to rip your pants off" kind? Definitely the latter.
I'd like to be writing one of those.
Pity I broke up with Jeremy.
- Could've been more fun, long-distance.
- Someone from home? A self-possessed dermatologist.
I'm afraid I broke his heart.
Well, it's 9:00.
And since you're writing rather than living out your prose - I'd venture to say you're alone.
- Yeah.
Fancy grabbing a drink? I would love to.
It is an unenviable job running the ER and making difficult cost-cutting decisions.
I got your message.
Jeanie came in quite upset about the budget.
And I was just explaining that it appears that you treated her honestly and fairly.
She gave herself a $25,000 raise.
That's from the administrative budget.
I understand that's your story.
But I don't buy it.
Something else is going on.
And what would that be? My HIV status.
Jeanie! I believe that's why I'm being fired.
I see.
Well Let's not do anything rash.
I am late for a dinner at the moment.
But tomorrow I can give the budget another more thorough review.
We've been over these figures a dozen times.
You told me we had to cut P.
A.
s.
Why don't you give Kerry and me another day to recheck our figures? Thank you, Dr.
Anspaugh.
I will.
Jeanie, you're really gonna use your HIV status like this? I call it as I see it.
I tried everything to keep you here.
Then I bent over backwards to help you get a job in Atlanta.
It just isn't fair, is it? I've never discriminated against you because of your HIV status.
I fought to keep you here.
Kerry, like you said before, it's nothing personal.
- To your health! - Thank you.
Here.
- What have we here? - What have we here? Another present? It's beautiful.
Should I try it on? You can try it on later.
I dream of the taste of your neck and the smell of your hair on my pillow.
You do? No, silly.
You do.
Did you mean everything you wrote? Yeah.
Yeah, I did.
It was I was homesick.
Do you remember this afternoon when I said that I will? I changed my mind.
I won't.
You won't? Not unless you go first.
Lie back.