ER s04e21 Episode Script
Suffer the Little Children
ER Previously on ER It was really lovely last night.
I would really like you to consider a date.
seeing as I do work for you I don't think it would be such a good idea.
Oh, I see.
You have a policy.
- Yes, I do.
- No fraternizing with people at work.
He's in heroin withdrawal.
The mother's stealing his methadone.
So she split? "Suffer The Little Children" Have you heard of the Velvet Lounge? Of course.
I saw in the Tribune they' re having a jam session tonight.
- You don't wanna go to the South Side.
- It's a rough area? I mean it's not a good idea.
When I was in Belfast, I went to the Bogside to hear Lick the Tins.
It's an IRA stronghold.
It's not the same thing.
Plans for his discharge? Well, his vitals are stable.
- Any vomiting or diarrhea? - No.
He's keeping down POs and is back on regular doses of methadone.
I'd like to start a course of long-term withdrawal.
- Mrs.
Thorvaldsen from DCFS come up? - Yes.
We had a team meeting.
He can't live with a mother that steals his methadone.
We all agree with your note.
The home is unsuitable.
And Social Services has found a foster family.
- Experienced with drug babies? - The mother is a retired nurse.
Yeah.
Just making sure you don't slip through the cracks, kiddo.
Hi, Carter! I wanted to catch you before you got in.
- Anything wrong? - No, everything's great.
You met my friend the other night from Philly? Max? You showing him the town? Remember I told you I was involved with somebody and it wasn't over yet? - Yeah, I figured he was the guy.
- Yeah.
- What about his heroin addiction? - Not heroin, painkillers.
Percoset.
He's okay.
Actually, he's here for a job.
He's coming in today to do a feasibility study on setting up a Pedes unit in the ER.
That doesn't sound like a coincidence.
Listen, Carter, before you run into him I've given you a one-sided picture of Max.
He's smart.
He's very dedicated.
He's a really good guy.
Want me to like him? Just don't judge him from things I've said in the past.
Sounds like you're back together.
I don't know about that.
Honestly, I don't.
- Where is he now? - My place.
Malik, who left this with my mail? Mr.
Dougherty from Salutech.
Yeah? See that it gets returned.
A salesman from Salutech left me a pen.
I got mine right here.
He also left free samples.
I won't be bribed into using their products.
Kerry, Mark, you know Dr.
Keinholz Chief of Pediatrics and Dean of the Med School.
This is Dr.
Rosher.
Doctors Greene, Weaver.
Nice to meet you.
Dr.
Rosher's a pediatrician and assistant professor at CHoP.
He's evaluating the need for pediatric emergency centers at ERs.
And we're fortunate he's responded to our call for a study here.
I thought this was under discussion.
It happens that Dr.
Rosher is free at this time.
I just finished a study at Hennepin County.
I have to scrub.
But give Dr.
Rosher the support he needs.
- Sure.
No problem.
- Thank you, doctors.
So they sprung me on you.
Sorry.
No.
It's fine.
I'd be happy to review our pediatric census statistics with you.
First, I'd like to see the place.
You can follow me, Dr.
Rosher.
I hate formality.
I'm Max.
- Mark.
- Kerry.
Could I stash my things? Get a cup of coffee? Randi, could you show him the lounge? Sure.
This comes from Doug Ross lobbying upstairs.
- It's just a study.
- You think he doesn't have an agenda? It's to fault how we handle pediatric patients.
We have nothing to hide.
We take great care of kids.
- Jeanie, do you have a busy morning? - Not so bad.
Why? Our talk on managing abdominal pain is next week.
- Could you get the slides? - Sure.
Thank you.
I warn you, if you don't see me making the coffee I would avoid it.
Mocha, vanilla, amaretto It's my own very personal stock.
Thanks.
You're? Randi, acting Unit Service Coordinator.
How's it going? Hi.
Meeting everyone? Yeah.
I encountered the usual dynamic.
The Attendings seeing me as the spy sent to undermine their authority.
How are you doing? It's awkward, seeing you here.
Was it awkward last night? No.
No.
But now you're nervous.
I don't know.
You show up and you're back in my life.
And it's not how I planned it.
I never planned it any other way.
- Peter? - Yeah? Have you got a presentation for morning report? Should I wait outside? When have you waited outside? You don't see me as a shy English rose? Elizabeth, I see you as many things.
Shy is not one of them.
Busy morning? A parathyroidectomy.
I know you like jazz.
So I was thinking maybe we could go to the Coq d'Or.
I hear the piano guy is pretty good.
Sure.
That'd be great.
- Yeah? - Yeah.
Peter? Hi, Lizzie.
Are we frequenting the men's locker room? - Peter, interested in a pyloroplasty? - I'm scrubbing in with Anspaugh.
- Got it.
- Oh, I'm free.
That's all right.
I got a backup.
Did he see us? I don't know.
At least one exam room with color murals and toys.
And section chairs so kids don't have to sit near a nut case.
You favor setting up a whole department? I'll get in trouble talking about this in front of him No need for caution on my account.
I'm keeping an open mind.
A department would be great.
But I'd settle for a full-time Attending.
That's the position Doug's out for.
Who gets it isn't important.
I won't lie to you.
I want the job.
It's a problem? Set up Pedes and what's next? Geriatric Emergency Medicine? Dr.
Del Amico, meet Dr.
Rosher.
Stay on your toes.
He's doing a study.
- I think she was born on her toes.
- Max was my Attending at CHoP.
Another ally.
I'm feeling outnumbered by pediatricians.
I'm double-boarded in Emergency Medicine and Pedes.
Dr.
Rosher? I've got some charts that could be relevant to your study.
- Sure.
- I'll set you up in the lounge.
Actually, I'm on a tour right now.
I have time to go over them with you right now.
I'll see someone gets you if any Pedes cases come in.
One Tina-Marie Chambliss.
Wouldn't give her age.
Fever and facial erythema following a face-lift.
- She came by ambulance? - It was a blepharo- and rhytidoplasty.
A wound infection.
Could she sign in under a different name to avoid being mobbed? - Mobbed? - Em, just let the doctors work.
Ma'am, you're gonna have to scoot on over here.
- Em- - Go on.
You're in good hands.
Ma'am, I am gonna have to examine your face.
I just look so awful.
Emmet, stay by me.
Don't leave me.
I'm right here, sweetie.
Channeling my love to help you mend.
- Temp's 102.
- Let's get a CBC blood cultures, start a line.
Do you have any allergies? She's allergic to sulfa antibiotics.
And to the ACE inhibitors.
Dr.
Emmet Chambliss, husband.
Charged with her care.
You're her physician? Doctor of Divinities.
I'm diabetic.
You probably should know that.
Malik, add a Chem-7.
Give her a gram of Ancef.
Do you take insulin? morning.
12 of NPH, five at night.
He gives me the shots.
I can't stand needles.
- What're you putting on my face? - Salt water.
I hope it's not too harsh for my skin.
This is the cleanser we normally use.
It's hypoallergenic.
Dr.
Del Amico, you've got a handle on this.
Yeah.
Thanks.
- What about our broadcast? - Don't worry, honey.
I can get a mobile truck and satellite uplink with one phone call.
But how long will I be sick? It's a serious infection.
You'll need IV antibiotics.
Probably gonna be a couple of days.
I've got a 2-year-old with rat bites.
Can we give him something for the pain? - I'll take a look at him.
- He's in Exam 2.
- What's the weight? -14 kilos.
Hey.
- When did this happen? - About 6 a.
m.
They heard him scream.
There were rats this big biting his fingers, eating him.
They thought he was fighting with his brother.
He's current on his vaccines and tetanus.
She says they attack all the children.
Okay.
We'll start an IV, titrate morphine for his pain.
It's through the palmar fascia.
Plastics should do it in the OR.
Let's irrigate this wound.
I'll get the authorities to make sure there are no more rats.
- He says they never do anything.
- Well, this time they will.
- Hi, Bob.
- Hey, Jeanie.
What's up? I had the flu and I can't seem to shake a cough.
We're seeing viral pneumonia.
You talk to a doc? I didn't want a big workup for nothing.
- You want a quick chest film? - Could you? You know, two weeks ago I cut my hand.
I just wanted a few stitches.
Next thing, I'm on a gurney hooked to an IV for 6 hours.
Some of these docs overreact.
Should I flash your name? No.
That's okay.
No problem.
No paperwork.
That's what I like.
Take a deep breath and hold.
You seen Dr.
Rosher? I got a 6-year-old with pityriasis.
Dr.
Weaver's holding him hostage.
I gave him some reading material.
We don't need to worry about occupying his time.
I want him to see how we work.
I'll get him out of there.
Lizzie, meet Tancred Baumgartner, 64.
History of hypertension and vascular disease.
80-pack-year smoker.
- Two packs a day for 40 years.
- But I'm cutting back.
I'm gonna get hypnotized.
- So, what brought you in today? - Terrible pain in my legs.
How far can you walk? Six months ago I could walk two blocks before I had to rest.
Now he can't walk to the toilet.
He's scheduled for a fem-pop bypass.
You should review his films.
Don't worry, Mr.
Baumgartner.
We'll put a spring back in your step.
I've been meaning to ask you.
Given more thought to that impressive offer you got recently? - Which impressive offer? - There's been more? The Senior Lecturer position at the Gloucestershire Royal Hospital.
- I decided to pass.
- Really? - Did you let them know? - I wrote them.
- Ouch! - What? Well, it takes guts, Lizzie.
You don't know if you have a future here.
And have him lay flat on his back for the next two hours.
- I'll hand-carry the specimens.
- Yeah, I'd appreciate that.
- Kerry, would you take a look at this? - Sure.
Oh, and don't forget to get a Gram's stain.
What do you got? dry cough and intermittent fever.
- Is she a smoker? - No.
- Any travel outside the country? - I don't think so.
Did you ask about her HIV status? I don't know if she's been tested.
Why? Might be an early infiltrate at the right base.
Or it may just be atelectasis.
- Where's the lateral? - That's all we have.
Repeat the film and have her take a deeper breath.
And get a lateral.
Also there's no name.
Let the techs know that that's really unacceptable.
- And Jeanie, the slides? - Sorry? This morning I asked you to get the slides.
Did you forget? No, I haven't had the time.
- Should someone else do it? - I'll get them now.
Okay.
We need some help! We were visiting my folks in Saint Lioba.
Our son just passed out.
- Gurney! - Got it.
Here, Malik.
- We'll need high-flow oxygen in 2.
- I'll get it.
- History of heart disease? - No.
- On any medications? - He's perfectly healthy.
He never gets sick.
My God! What's wrong with him?! He's tachy at 150.
Resps high at 28.
Why is he breathing so fast? - Does he have asthma? - No.
All right, Conni.
Put him on a pulse ox and EKG.
I want a CBC, Chem-7, blood gas, chest film.
I'll start a line.
Sam? Sam, can you hear me? - What's wrong? - He's cyanotic.
See how blue his lips are? - He's not getting enough oxygen.
- Why? That's what we'll figure out.
How are you doing? - Just trying to look decent again.
- I don't think that's a good idea.
I can't be seen on TV without my woolly bears and make-up.
- You ever see us on the JGCN? - No.
Jesus Gospel Cable Network? Makeup'll make it worse, Mrs.
Chambliss.
Oh, no.
Honey, you call me Tina-Marie.
Hello, doctor.
Isn't she an angel? I see the power of prayer and modern medicine.
Well, we have her blood test results.
And there is reason for concern.
My face? Actually, your kidneys are the problem.
I'm passing water.
Your BUN and creatinine are elevated, indicating kidney problems.
- Probably from your diabetes.
- Emmet? Doctor, what does this exactly mean? It could simply be dehydration.
I'll give you IV fluids and hope your renal function improves.
I'll also do a neuro exam for sensation in your extremities.
Whatever suits you, honey.
Feel that? Little pricks of pain.
That's good.
That means you're not losing feeling in your feet and toes.
Look out, Emmet.
She might test your heart.
I'm just kidding, sweetie.
Just kidding.
So if my kidneys fail what then? If it progresses to renal failure, you'll need dialysis.
This means a full prayer vigil, Emmet! Yes, we'll pray for those kidneys! Malik, know anyone in Public Health to deal with a rat problem? - Office for Rodent Control.
- I got a contact there.
- I'll put you through.
- They were eating this kid alive.
In Philly, Animal Control was better than Public Health.
This woman, Miss Weldon, is a real crusader.
She'll get them in there.
Poison, traps, whatever they have to do.
Dr.
Greene? Dr.
Carter wants to see you in Trauma 2.
Thanks, Yosh.
Here.
Mention my name.
I treated her son once.
Come on.
You picked a good day for Pedes cases.
He seems a little better.
Why won't he wake up? - Isn't the oxygen helping? - It's helping.
And for now, he's stable.
I just haven't found what's wrong.
- Dr.
Carter, meet Dr.
Rosher.
- We've met.
- Yep.
Hi.
- What do you got? This is Sam Adams, 11 years old, altered.
Presented with cyanosis, tachypnea, tachycardia driving back from the farm.
Still cyanotic despite O2, 10 liters.
What are you thinking? Either a VQ mismatch or something toxic-metabolic? - Pulse ox? -92.
It's pretty good.
- Was he in a camper or a pickup? - He was in a car with us.
- Chest and cardiac exam? - No wheezing or rales.
Regular without murmur, rub or gallop.
- Blood gas? - PCO2's 35.
PO2's 380.
- Suggesting - Oxygen in blood, but still cyanotic.
- What kind of farm was it? - My father raises tulips.
- Greenhouses.
- I already asked about that.
Some of the pesticides in a hothouse contain cyanide.
He'd have pinked up with the oxygen.
Besides, I've got good pulses and there's no smell of almonds.
So your best educated guess? Methemoglobinemia.
Do another blood gas.
Check that.
Go for it.
Tough case, leaving it with an intern.
Is it ill-advised? - You know Dr.
Carter.
I don't.
- He just figured it out.
Diagnosis was correct.
But you didn't tell him.
He's here to learn.
Not to be told.
Is that a mark against me? Not in my book.
-500 cc fluid bolus is onboard.
- TKO the line.
Okay.
I got it.
There it is.
There's the answer.
Look at that arterial blood.
That's blood? Looks like chocolate.
- It's methemoglobin.
- What? A form of hemoglobin that can't carry oxygen into the body.
How'd he get that? From a drug or toxin.
We can treat it.
Take that to the lab and bring back methylene blue.
Peter.
Hey.
I thought you had a fem-pop? Done.
I'm assisting on a lung biopsy, then on a triple A.
Look, I think Romano saw us.
- What did he say? - You know him.
He didn't say it directly.
But he told me I should've accepted the position at the Royal.
He was saying he wasn't going to continue my sponsorship.
I suppose it's a matter of insult to injury.
Because he came on to you? Peter, the man has an elephantine ego.
I'm not going for that.
Maybe it was inevitable.
Being sponsored by him was difficult at the best of times.
Elizabeth, listen to me.
He doesn't own you.
He can't do this, okay? We'll talk later.
I have to scrub.
Yeah.
We'll explore to see if there's flexor tendon injury.
Chuny, take the parents to the waiting room.
See if Pedes has a post-op bed assignment.
- Doug, Dr.
Nagarwala's here.
- All right.
- What's up? - Sorry to bother you but a woman came from DCFS, a Miss Neuman.
She said the case status had changed and she's taking Josh back to his mother.
- When? - Just now.
I came down when she left.
None of the doctors agree.
We're going to make a formal appeal.
No, there's no time for that.
I need the County Health Department in Saint Lioba.
Home of the White Corn Festival.
I went there with bikers once.
They had pig-calling.
Ever see that? Can't say I have.
When you get that number, will you page me? How's it going? - I got a kid with methemoglobinemia.
- That's a great case.
What was the inducer? Tox screen was negative.
But he was on a farm.
So I'm getting the local health authorities to check it out.
- Are you taking care of Tina-Marie? - Yes.
My mom watches them and she said they announced they're broadcasting live and she's dying.
- No, that is not happening.
- She's not dying? No, and they're not broadcasting from here.
Dr.
Greene said no way.
She and my aunt are by the TV with their credit cards.
Talking about those televangelists? - Yeah, Dr.
Emmet and Tina-Marie.
- They have some clout.
I just got a call from Administration saying we're to let them do a broadcast.
Adele? Hey, Adele! Hey, you're tough to catch up to.
- Josh is my patient.
- I read the report.
You know the situation with his mother.
Sure, but there's been a change in the environment.
His mother now lives with her aunt.
We feel that the aunt can take care of Josh.
- He's addicted to methadone.
- I know his medical history.
But my obligation is to return the child.
- Can you hold this? - Yeah.
We'll carefully monitor his progress.
We understand the situation.
As long as he needs methadone, she'll steal it from him.
I'm sorry.
He has to go home.
Okay, how is the aunt gonna pay for the meds? - He's on Medicaid.
- Okay.
Some of the meds are formulary.
I'll have to fill out an authorization.
- Dr.
Ross- - We examine him and give him everything.
How long is this gonna take? Just long enough to fill out some forms.
- Here we go.
Come on.
- Okay.
Okay, come here.
- I got him.
- All right.
Just give me a second to lock up my car.
Here we go.
- Come on.
Got it? - Got everything.
Okay, here we go.
All right, Josh.
Deep breaths for me.
I'm hearing basilar rales on the left.
Get a CBC, blood culture and a chest film.
- Why? What's wrong? - Could be pneumonia.
- Pneumonia? - Want to hear for yourself? What do I say to the mother? How long does he have to stay? Four hours for test results.
If it is, we'll put him on IV antibiotics.
That means he'll spend the night? Could be, yeah.
Okay.
All right.
Kid looks pretty good.
No fever.
You sure you heard rales? There's no rales.
I'm keeping him.
What's going on? We got a 7-month-old baby admitted twice for withdrawal.
I'm not sending him home to be a methadone source for his mother.
- Can't Child Services take care of it? - I'll do an ultrarapid detox and end his addiction today.
- Ultrarapid? What does that mean? - Quick withdrawal under deep sedation.
He's going cold turkey right here? I spoke to a pediatric anesthesiologist.
I know the procedure.
It can be done safely.
How long will it take? You're gonna hide him here for 12 hours? I don't have a choice.
- You can't do it alone.
- Yes, I can.
- No, you can't.
- Don't put anything at risk.
Yeah.
Well, if we get caught we'll both help each other through real-estate school.
Put him on cardiac monitor and pulse ox.
I'll do an arterial line.
We'll need a ventilator.
Okay? Okay.
Here's the second dose.
Let's run that over five minutes.
How you doing? I feel a bit tired, but otherwise I'm okay.
Are my mom and dad around? Yeah.
They went to go make some phone calls.
I can go get them.
No hurry.
How is your patient? Aside from his color? He's improving.
Good call, John.
Gotta figure out its cause.
See who else is at risk.
I've heard a lot about you from Anna.
- Really? - Yeah.
She told me you've become close friends.
I heard about your cousin.
I'm sure she was a big help.
She told you about that? - You know Anna doesn't keep secrets.
- Yeah.
I don't really see how that concerns you, though.
Well, what she's learned about drug addiction she had the misfortune to learn through me, John.
I know it's private.
I meant no offense.
No, forget it.
- Dr.
Romano.
- Peter.
You're a "dried fruits and nuts" guy.
Nothing healthy here.
I was looking for you.
You found me.
- You don't mind if I eat? - No.
So, what's up? What Elizabeth and I do in our personal lives should not impact her career.
In your personal lives.
What's that? You saw us in the lockers, then hinted that she won't receive sponsorship next year.
Now, we both know that's not right.
Look, I had no idea you and Lizzie were an item.
I swear I didn't.
But don't worry.
I mean, I'm happy for you.
So you didn't see us? No.
But you're having an affair.
Terrific.
It puts things in perspective.
Hey.
Congratulations.
Excellent choice.
- Need help? - No, I got it.
- Who needs a vent? - Nobody.
Respiratory called.
They need it upstairs.
Mr.
Chambliss.
Dr.
Chambliss.
I want you to know I think this broadcast is inappropriate.
I assure you, as I did Public Affairs, you'll be referred to positively.
Dr.
Del Amico? Stay in the room during the broadcast and if you feel Mrs.
Chambliss' health is being compromised, call me.
No problem.
A little help here! I got it.
What do we got? Cylla Voliotis, age 12.
Blunt trauma to the right eye, concussion, possible facial fracture.
Let's go to Trauma 1.
- You the mother? - No, Phys Ed teacher.
She was running and hit a lamppost.
The school call the mother? They're trying, but I have an emergency consent form.
Good.
Good.
Okay, nice and easy.
On my count.
One, two, three - It hurts so bad! - I know.
Don't worry.
- We'll take care of you.
- Morphine? Let's start with four.
- Partially extruded globe.
- She have vision? - Can you see, darling? - It's all red and blurry.
- How many fingers am I holding up? - Three.
Good.
Good.
Iris and lens are intact.
No vitreous hemorrhage or detached retina.
Okay.
Let's get 1 percent lidocaine.
With that, Betadine and a Steri-Drape.
No Ophtho consult? No, we've done this before.
All right, he's out.
Let's tube him.
How do we know when withdrawal's complete? After 12 hours of the Narcan blocking the narcotic about a 98 percent success rate.
When he wakes up, he shouldn't have withdrawal symptoms.
I'm in.
Pulse ox 98.
BP? Good breath.
Heart rate? Let him settle down a bit.
How's it going, Cylla? I'm scared.
Alcaine's in.
- You feel that? - What? I think we're about ready to go.
So, what kind of music do you like? Spice Girls.
Who's your favorite Spice? Yosh, methyl cellulose.
What is it? Sporty Spice, All Spice Cylla Spice? No, I like Posh.
Okay, good.
I need you just to hold still.
Okay, hold still.
- Sterile applicator.
- Here you go.
I'm just gonna evert the lashes.
There.
I can see a little better.
Yosh, eye shield.
It's gonna be a little blurry for a while and a little sore.
Let me know when her parents arrive.
She'll need an orbital CT and Ophtho can see her.
Praise the Lord, yes! Praise him for his blessing prompted by your prayers and offerings.
It is only by your faith that I will survive my ordeal.
Only hours ago when pain coursed through me Emmet Emmet, you tell them.
Brothers and sisters, the Lord has put another trial before us.
Tina-Marie just learned from this lovely lady- No, she's not a movie star.
This is Tina-Marie's doctor.
Will you tell us the nature of her illness? She has cellulitis and renal insufficiency.
And what does that mean? She has a problem with her kidneys.
- But she will survive? - Yes.
Yes! She will survive through the power of Christ Jesus and by your prayers and offerings.
Emmet, Emmet, Emmet! I can feel the power of prayer right now! I can feel it! It has started! We all feel it, honey.
Do you feel it, doctor? - No.
- Well, come on.
Here, take Tina-Marie's hand.
We will have a prayer interface.
People are watching and waiting for you, honey.
Yes? Feel the power of the love that courses through us.
God, through you will save my life! Kerry? Got another set of x-rays.
Let's have a look.
Is there a name on these? They're mine.
These are much better images.
- Did you look at these? - No.
Well, it looks clean.
- Why'd you order them? Cough? Fever? - Yeah.
- Night sweats? - No, but I have trouble sleeping.
Forgetfulness? Those slides, I put in your mailbox.
But yeah, there's been forgetfulness.
I want you to know something.
Whatever your status, even if you have a measurable viral count no one's going to overreact.
There's going to be a job for you here.
We should draw some blood.
- He didn't see us? - That's what he claims.
I misread him, and you told him about us.
I told him that nothing we do should affect your standing here.
You got heavy with him? Yeah.
Maybe I should've kept my mouth shut.
Taking up my cause was very gallant of you, Peter.
But it seems we've gone public.
- Good breath sounds bilaterally.
- Heart rate's down to 100.
- Pulse ox 99.
- He's stable.
Start a second line and be ready before we give him the Narcan.
- Are there gonna be side effects? - It'll make him hypertensive.
We have Nipride, but no esmolol.
I want to have both ready on drips.
- I'll go get them.
- No.
I'll do it.
Kerry Weaver might wonder why you're here after your shift.
Suction.
Lizzie, can you retract distally? Good.
I got the room I need.
Now we can all settle back.
Shirley, let me ask you something.
Suppose you asked someone on a date- I'm married.
Hypothetically.
It's a long procedure.
You ask them out and they beg off, claiming they don't get involved with work colleagues.
- Got some oozing.
- Got it.
Then you find out they're having an affair with a colleague.
Now, why do you suppose they lied? The colleague is married.
Married person's response.
But say he's not married.
They didn't want to offend an overblown ego.
It's a thought.
But suppose this person made up that story about keeping sex and work separate so they could continue playing the field.
That's absurd.
Clamp again.
Right here.
I don't know.
Shirley? I agree.
They're probably still shopping around.
- Your shift ended hours ago.
- I got involved.
- Esmolol? - Teenager with a tachy arrhythmia.
- How about adenosine? - I already tried it.
Lasted for a few seconds.
It's under control.
Dr.
Carter, I just got this fax for you.
This is the explanation for the methemoglobinemia.
Really? It's from a local health service near the farm.
"Ground water from several areas has been found to have heavy nitrite concentration from inorganic waste contamination.
" Test the parents.
They might be borderline.
Yeah.
I did that already.
I'm just waiting on the test results.
- Are the labs back on Chambliss? - Here.
Thank you.
Pedes case? I'll put it in my study.
Sorry.
It's a repeat glucose on the televangelist.
- I heard you look great on TV.
- Someone saw me? - The nurses had it on in the lounge.
- What a nightmare! Total frauds.
Not serious? But I phoned in a big pledge! The woman used her disease to milk money out of poor people who probably believe all of it.
It's a living.
At least they're not practicing law or polluting streams, selling insurance What's the deal on getting a genuine Philly cheese steak? I've looked.
They don't exist.
Italian? I'm on a substantial per diem.
And I'm on call.
Chinese? How about a candlelit dinner in the lounge? I'd love to.
Jeanie, could I see you? Sure, Kerry.
You can go.
I'll bandage him.
Thanks, Yosh.
I got your labs back.
I'm very happy to say it's all good news.
Your viral load remains non-detectable your white count's normal and you're not even anemic.
Guess I was worked up over nothing.
I can understand.
But I took responsibility for monitoring your health.
You shouldn't be on your own looking at x-rays.
Yeah, you're right.
That won't happen again.
What about the forgetfulness? You complained of sleeplessness.
I haven't slept much this month.
- Are you taking anything? - Lately I've been taking Halcion.
Which could explain Okay.
The fact is, Jeanie- I mean, you've had such a rough time.
With Al moving away and Scotty That alone could explain your symptoms.
Yeah, you're right.
If you ever wanna talk Thanks, Kerry.
I'd like that.
Good.
Figures are 10 percent above projections.
I think there'll be real cassette sales.
Well, what about next time? Do I die on the TV? Don't make stupid jokes.
Your blood sugar's still elevated.
I need to give you more insulin.
I'm gonna make some phone calls, sweetie.
How often do you test your blood sugar at home? What's that you're supposed to do? Four times a day? I don't know.
To prevent complications, yes.
Well, what kind of complications? Blindness, heart attack, loss of peripheral circulation.
Those are all good prayer vigils.
I'm not joking.
Take responsibility for your health.
Take your problems seriously.
Honey, my problems are all I got.
You wouldn't make a living without them.
Well, I sure as heck wouldn't have Emmet.
You're a lovely thing.
- Are you married? - No.
Emmet and I were married when we were in high school.
Oh, we were crazy in love.
You'd never know it now, would you? It's not for me to make a judgment about that.
I'll tell you one thing.
Emmet won't leave me.
Ever.
God has given me the way to keep him close.
He may not love me.
But he loves the way caring for me makes him look.
I wouldn't be in a marriage without love.
Oh, honey, everyone thinks that.
But things change.
And you make do.
So be careful.
Thank you.
So I suppose the Coq d'Or's a bit dressy? Yeah.
But actually, I didn't make reservations there.
- Our date's off? - No, no.
We're going to the Velvet Lounge.
That's fantastic.
- They'll look at us like we're crazy.
- You know that doesn't bother me.
Wish I could say the same.
Look, I can't change what I am any more than you can.
Whatever feelings I have for you are based on who you are not what I want you to be.
Elizabeth, you're not from here.
I mean, you didn't grow up the way I did.
I wish I could say my feelings about your skin color would disappear.
But it doesn't work like that.
Do you understand? Yes.
But I don't want to subject you to something you're not ready for.
You know, I've never met anybody that makes me laugh or blush, or whatever, the way you do.
I'm trying to work through this.
You gotta trust me, all right? Come on, let's go to the Velvet Lounge.
Hey.
Philly cheese steaks.
I found them here.
And they deliver.
Can you believe that? Want one? More than enough.
No, thanks.
Oh, come on! You get a free angioplasty with a small order.
Free quadruple bypass with the dinner special? No? I was wondering.
Maybe you'd like to join Anna and I for dinner sometime.
You really want an ally.
No.
It's about your friendship with her.
I don't want her to cut herself off from people she likes.
Make it easier to go back to you.
Am I hearing jealousy? Maybe once.
Not now.
I just think you're trouble.
Maybe I'm wrong.
I sort of hope I am.
But that's what I think.
I might laugh at your jokes, never giving an indication of how I feel.
But I wanted you to know that.
Enjoy your dinner.
Hey, Mark.
I've been thinking.
This storage area off the hallway could be made a pediatric exam room.
- The janitor's closet? - Children's beds are small.
We could hang the IV bags on the hooks used for brooms.
This is a joke.
Maybe I'm facing reality.
You're obviously behind the idea.
You gave Rosher a grand tour.
He was very impressed at how we handle our Pedes cases.
Doug's your friend.
You think Rosher's report will get him an Attending position.
I appreciate loyalty, but not at the expense of the ER.
That has nothing to do with it.
I don't believe a Pedes unit or Attending is a big improvement.
Dr.
Greene, Jeanie wants you to sign off on a suture job.
Will you go on record with that? Absolutely.
When the time's right.
Where is she? - Pulse ox 89.
- What's going on? Decreased breath on the left.
A collapsed lung? Should I get a portable x-ray? Can't be.
Pressure's not that high.
I'll give him 100 percent oxygen.
- Could be a mucus plug.
- I'll get a suction catheter.
Looks good.
- Infected abrasion? - Here.
She cleaned it good.
I'll change it when you come back.
Sure.
On Thursday.
- It's secretions.
Hook up the vent.
- Pulse ox 98.
What the hell is this? This boy is my patient- Ketamine? What're you doing? An ultrarapid detox.
Everything's under control.
Like hell it is.
Is this baby even a registered patient? - He- - Is he on the board? If you'll just let me explain- You don't have consent, do you? You've got an intubated kid under deep sedation? - It's under control.
- We gotta move this kid.
- Hear me out- - No.
- BP 190/100.
- Nipride, 0.
3 mcgs per kilo - per minute- - Gina, bag him.
- Let's get to the PICU.
- We can do it right here.
- His chart? - I don't have one.
Is this how you practice medicine? - I wrote everything on that paper.
- Oh, that's great.
Inga, call the PICU.
Critical patient coming up.
- I need a name.
- Name? - We don't have to.
- What's the name? - Josh McNeal.
- Baby McNeal.
About six months old.
Ketamine drip.
Intubated.
What's going on? I found Doug in Exam 4, detoxing this baby.
- What?! - I found him by accident.
- Did you know? - I was helping him.
Helping him?! - He was stable, Kerry.
- This is a violation of every policy.
- Bed's ready.
- Tell them I'm bringing him up! - I'm going too.
- You're damn right! You're gonna explain to the Administration and the Executive Committee! Let's go! You lied to me.
You looked me in the face and lied.
I would really like you to consider a date.
seeing as I do work for you I don't think it would be such a good idea.
Oh, I see.
You have a policy.
- Yes, I do.
- No fraternizing with people at work.
He's in heroin withdrawal.
The mother's stealing his methadone.
So she split? "Suffer The Little Children" Have you heard of the Velvet Lounge? Of course.
I saw in the Tribune they' re having a jam session tonight.
- You don't wanna go to the South Side.
- It's a rough area? I mean it's not a good idea.
When I was in Belfast, I went to the Bogside to hear Lick the Tins.
It's an IRA stronghold.
It's not the same thing.
Plans for his discharge? Well, his vitals are stable.
- Any vomiting or diarrhea? - No.
He's keeping down POs and is back on regular doses of methadone.
I'd like to start a course of long-term withdrawal.
- Mrs.
Thorvaldsen from DCFS come up? - Yes.
We had a team meeting.
He can't live with a mother that steals his methadone.
We all agree with your note.
The home is unsuitable.
And Social Services has found a foster family.
- Experienced with drug babies? - The mother is a retired nurse.
Yeah.
Just making sure you don't slip through the cracks, kiddo.
Hi, Carter! I wanted to catch you before you got in.
- Anything wrong? - No, everything's great.
You met my friend the other night from Philly? Max? You showing him the town? Remember I told you I was involved with somebody and it wasn't over yet? - Yeah, I figured he was the guy.
- Yeah.
- What about his heroin addiction? - Not heroin, painkillers.
Percoset.
He's okay.
Actually, he's here for a job.
He's coming in today to do a feasibility study on setting up a Pedes unit in the ER.
That doesn't sound like a coincidence.
Listen, Carter, before you run into him I've given you a one-sided picture of Max.
He's smart.
He's very dedicated.
He's a really good guy.
Want me to like him? Just don't judge him from things I've said in the past.
Sounds like you're back together.
I don't know about that.
Honestly, I don't.
- Where is he now? - My place.
Malik, who left this with my mail? Mr.
Dougherty from Salutech.
Yeah? See that it gets returned.
A salesman from Salutech left me a pen.
I got mine right here.
He also left free samples.
I won't be bribed into using their products.
Kerry, Mark, you know Dr.
Keinholz Chief of Pediatrics and Dean of the Med School.
This is Dr.
Rosher.
Doctors Greene, Weaver.
Nice to meet you.
Dr.
Rosher's a pediatrician and assistant professor at CHoP.
He's evaluating the need for pediatric emergency centers at ERs.
And we're fortunate he's responded to our call for a study here.
I thought this was under discussion.
It happens that Dr.
Rosher is free at this time.
I just finished a study at Hennepin County.
I have to scrub.
But give Dr.
Rosher the support he needs.
- Sure.
No problem.
- Thank you, doctors.
So they sprung me on you.
Sorry.
No.
It's fine.
I'd be happy to review our pediatric census statistics with you.
First, I'd like to see the place.
You can follow me, Dr.
Rosher.
I hate formality.
I'm Max.
- Mark.
- Kerry.
Could I stash my things? Get a cup of coffee? Randi, could you show him the lounge? Sure.
This comes from Doug Ross lobbying upstairs.
- It's just a study.
- You think he doesn't have an agenda? It's to fault how we handle pediatric patients.
We have nothing to hide.
We take great care of kids.
- Jeanie, do you have a busy morning? - Not so bad.
Why? Our talk on managing abdominal pain is next week.
- Could you get the slides? - Sure.
Thank you.
I warn you, if you don't see me making the coffee I would avoid it.
Mocha, vanilla, amaretto It's my own very personal stock.
Thanks.
You're? Randi, acting Unit Service Coordinator.
How's it going? Hi.
Meeting everyone? Yeah.
I encountered the usual dynamic.
The Attendings seeing me as the spy sent to undermine their authority.
How are you doing? It's awkward, seeing you here.
Was it awkward last night? No.
No.
But now you're nervous.
I don't know.
You show up and you're back in my life.
And it's not how I planned it.
I never planned it any other way.
- Peter? - Yeah? Have you got a presentation for morning report? Should I wait outside? When have you waited outside? You don't see me as a shy English rose? Elizabeth, I see you as many things.
Shy is not one of them.
Busy morning? A parathyroidectomy.
I know you like jazz.
So I was thinking maybe we could go to the Coq d'Or.
I hear the piano guy is pretty good.
Sure.
That'd be great.
- Yeah? - Yeah.
Peter? Hi, Lizzie.
Are we frequenting the men's locker room? - Peter, interested in a pyloroplasty? - I'm scrubbing in with Anspaugh.
- Got it.
- Oh, I'm free.
That's all right.
I got a backup.
Did he see us? I don't know.
At least one exam room with color murals and toys.
And section chairs so kids don't have to sit near a nut case.
You favor setting up a whole department? I'll get in trouble talking about this in front of him No need for caution on my account.
I'm keeping an open mind.
A department would be great.
But I'd settle for a full-time Attending.
That's the position Doug's out for.
Who gets it isn't important.
I won't lie to you.
I want the job.
It's a problem? Set up Pedes and what's next? Geriatric Emergency Medicine? Dr.
Del Amico, meet Dr.
Rosher.
Stay on your toes.
He's doing a study.
- I think she was born on her toes.
- Max was my Attending at CHoP.
Another ally.
I'm feeling outnumbered by pediatricians.
I'm double-boarded in Emergency Medicine and Pedes.
Dr.
Rosher? I've got some charts that could be relevant to your study.
- Sure.
- I'll set you up in the lounge.
Actually, I'm on a tour right now.
I have time to go over them with you right now.
I'll see someone gets you if any Pedes cases come in.
One Tina-Marie Chambliss.
Wouldn't give her age.
Fever and facial erythema following a face-lift.
- She came by ambulance? - It was a blepharo- and rhytidoplasty.
A wound infection.
Could she sign in under a different name to avoid being mobbed? - Mobbed? - Em, just let the doctors work.
Ma'am, you're gonna have to scoot on over here.
- Em- - Go on.
You're in good hands.
Ma'am, I am gonna have to examine your face.
I just look so awful.
Emmet, stay by me.
Don't leave me.
I'm right here, sweetie.
Channeling my love to help you mend.
- Temp's 102.
- Let's get a CBC blood cultures, start a line.
Do you have any allergies? She's allergic to sulfa antibiotics.
And to the ACE inhibitors.
Dr.
Emmet Chambliss, husband.
Charged with her care.
You're her physician? Doctor of Divinities.
I'm diabetic.
You probably should know that.
Malik, add a Chem-7.
Give her a gram of Ancef.
Do you take insulin? morning.
12 of NPH, five at night.
He gives me the shots.
I can't stand needles.
- What're you putting on my face? - Salt water.
I hope it's not too harsh for my skin.
This is the cleanser we normally use.
It's hypoallergenic.
Dr.
Del Amico, you've got a handle on this.
Yeah.
Thanks.
- What about our broadcast? - Don't worry, honey.
I can get a mobile truck and satellite uplink with one phone call.
But how long will I be sick? It's a serious infection.
You'll need IV antibiotics.
Probably gonna be a couple of days.
I've got a 2-year-old with rat bites.
Can we give him something for the pain? - I'll take a look at him.
- He's in Exam 2.
- What's the weight? -14 kilos.
Hey.
- When did this happen? - About 6 a.
m.
They heard him scream.
There were rats this big biting his fingers, eating him.
They thought he was fighting with his brother.
He's current on his vaccines and tetanus.
She says they attack all the children.
Okay.
We'll start an IV, titrate morphine for his pain.
It's through the palmar fascia.
Plastics should do it in the OR.
Let's irrigate this wound.
I'll get the authorities to make sure there are no more rats.
- He says they never do anything.
- Well, this time they will.
- Hi, Bob.
- Hey, Jeanie.
What's up? I had the flu and I can't seem to shake a cough.
We're seeing viral pneumonia.
You talk to a doc? I didn't want a big workup for nothing.
- You want a quick chest film? - Could you? You know, two weeks ago I cut my hand.
I just wanted a few stitches.
Next thing, I'm on a gurney hooked to an IV for 6 hours.
Some of these docs overreact.
Should I flash your name? No.
That's okay.
No problem.
No paperwork.
That's what I like.
Take a deep breath and hold.
You seen Dr.
Rosher? I got a 6-year-old with pityriasis.
Dr.
Weaver's holding him hostage.
I gave him some reading material.
We don't need to worry about occupying his time.
I want him to see how we work.
I'll get him out of there.
Lizzie, meet Tancred Baumgartner, 64.
History of hypertension and vascular disease.
80-pack-year smoker.
- Two packs a day for 40 years.
- But I'm cutting back.
I'm gonna get hypnotized.
- So, what brought you in today? - Terrible pain in my legs.
How far can you walk? Six months ago I could walk two blocks before I had to rest.
Now he can't walk to the toilet.
He's scheduled for a fem-pop bypass.
You should review his films.
Don't worry, Mr.
Baumgartner.
We'll put a spring back in your step.
I've been meaning to ask you.
Given more thought to that impressive offer you got recently? - Which impressive offer? - There's been more? The Senior Lecturer position at the Gloucestershire Royal Hospital.
- I decided to pass.
- Really? - Did you let them know? - I wrote them.
- Ouch! - What? Well, it takes guts, Lizzie.
You don't know if you have a future here.
And have him lay flat on his back for the next two hours.
- I'll hand-carry the specimens.
- Yeah, I'd appreciate that.
- Kerry, would you take a look at this? - Sure.
Oh, and don't forget to get a Gram's stain.
What do you got? dry cough and intermittent fever.
- Is she a smoker? - No.
- Any travel outside the country? - I don't think so.
Did you ask about her HIV status? I don't know if she's been tested.
Why? Might be an early infiltrate at the right base.
Or it may just be atelectasis.
- Where's the lateral? - That's all we have.
Repeat the film and have her take a deeper breath.
And get a lateral.
Also there's no name.
Let the techs know that that's really unacceptable.
- And Jeanie, the slides? - Sorry? This morning I asked you to get the slides.
Did you forget? No, I haven't had the time.
- Should someone else do it? - I'll get them now.
Okay.
We need some help! We were visiting my folks in Saint Lioba.
Our son just passed out.
- Gurney! - Got it.
Here, Malik.
- We'll need high-flow oxygen in 2.
- I'll get it.
- History of heart disease? - No.
- On any medications? - He's perfectly healthy.
He never gets sick.
My God! What's wrong with him?! He's tachy at 150.
Resps high at 28.
Why is he breathing so fast? - Does he have asthma? - No.
All right, Conni.
Put him on a pulse ox and EKG.
I want a CBC, Chem-7, blood gas, chest film.
I'll start a line.
Sam? Sam, can you hear me? - What's wrong? - He's cyanotic.
See how blue his lips are? - He's not getting enough oxygen.
- Why? That's what we'll figure out.
How are you doing? - Just trying to look decent again.
- I don't think that's a good idea.
I can't be seen on TV without my woolly bears and make-up.
- You ever see us on the JGCN? - No.
Jesus Gospel Cable Network? Makeup'll make it worse, Mrs.
Chambliss.
Oh, no.
Honey, you call me Tina-Marie.
Hello, doctor.
Isn't she an angel? I see the power of prayer and modern medicine.
Well, we have her blood test results.
And there is reason for concern.
My face? Actually, your kidneys are the problem.
I'm passing water.
Your BUN and creatinine are elevated, indicating kidney problems.
- Probably from your diabetes.
- Emmet? Doctor, what does this exactly mean? It could simply be dehydration.
I'll give you IV fluids and hope your renal function improves.
I'll also do a neuro exam for sensation in your extremities.
Whatever suits you, honey.
Feel that? Little pricks of pain.
That's good.
That means you're not losing feeling in your feet and toes.
Look out, Emmet.
She might test your heart.
I'm just kidding, sweetie.
Just kidding.
So if my kidneys fail what then? If it progresses to renal failure, you'll need dialysis.
This means a full prayer vigil, Emmet! Yes, we'll pray for those kidneys! Malik, know anyone in Public Health to deal with a rat problem? - Office for Rodent Control.
- I got a contact there.
- I'll put you through.
- They were eating this kid alive.
In Philly, Animal Control was better than Public Health.
This woman, Miss Weldon, is a real crusader.
She'll get them in there.
Poison, traps, whatever they have to do.
Dr.
Greene? Dr.
Carter wants to see you in Trauma 2.
Thanks, Yosh.
Here.
Mention my name.
I treated her son once.
Come on.
You picked a good day for Pedes cases.
He seems a little better.
Why won't he wake up? - Isn't the oxygen helping? - It's helping.
And for now, he's stable.
I just haven't found what's wrong.
- Dr.
Carter, meet Dr.
Rosher.
- We've met.
- Yep.
Hi.
- What do you got? This is Sam Adams, 11 years old, altered.
Presented with cyanosis, tachypnea, tachycardia driving back from the farm.
Still cyanotic despite O2, 10 liters.
What are you thinking? Either a VQ mismatch or something toxic-metabolic? - Pulse ox? -92.
It's pretty good.
- Was he in a camper or a pickup? - He was in a car with us.
- Chest and cardiac exam? - No wheezing or rales.
Regular without murmur, rub or gallop.
- Blood gas? - PCO2's 35.
PO2's 380.
- Suggesting - Oxygen in blood, but still cyanotic.
- What kind of farm was it? - My father raises tulips.
- Greenhouses.
- I already asked about that.
Some of the pesticides in a hothouse contain cyanide.
He'd have pinked up with the oxygen.
Besides, I've got good pulses and there's no smell of almonds.
So your best educated guess? Methemoglobinemia.
Do another blood gas.
Check that.
Go for it.
Tough case, leaving it with an intern.
Is it ill-advised? - You know Dr.
Carter.
I don't.
- He just figured it out.
Diagnosis was correct.
But you didn't tell him.
He's here to learn.
Not to be told.
Is that a mark against me? Not in my book.
-500 cc fluid bolus is onboard.
- TKO the line.
Okay.
I got it.
There it is.
There's the answer.
Look at that arterial blood.
That's blood? Looks like chocolate.
- It's methemoglobin.
- What? A form of hemoglobin that can't carry oxygen into the body.
How'd he get that? From a drug or toxin.
We can treat it.
Take that to the lab and bring back methylene blue.
Peter.
Hey.
I thought you had a fem-pop? Done.
I'm assisting on a lung biopsy, then on a triple A.
Look, I think Romano saw us.
- What did he say? - You know him.
He didn't say it directly.
But he told me I should've accepted the position at the Royal.
He was saying he wasn't going to continue my sponsorship.
I suppose it's a matter of insult to injury.
Because he came on to you? Peter, the man has an elephantine ego.
I'm not going for that.
Maybe it was inevitable.
Being sponsored by him was difficult at the best of times.
Elizabeth, listen to me.
He doesn't own you.
He can't do this, okay? We'll talk later.
I have to scrub.
Yeah.
We'll explore to see if there's flexor tendon injury.
Chuny, take the parents to the waiting room.
See if Pedes has a post-op bed assignment.
- Doug, Dr.
Nagarwala's here.
- All right.
- What's up? - Sorry to bother you but a woman came from DCFS, a Miss Neuman.
She said the case status had changed and she's taking Josh back to his mother.
- When? - Just now.
I came down when she left.
None of the doctors agree.
We're going to make a formal appeal.
No, there's no time for that.
I need the County Health Department in Saint Lioba.
Home of the White Corn Festival.
I went there with bikers once.
They had pig-calling.
Ever see that? Can't say I have.
When you get that number, will you page me? How's it going? - I got a kid with methemoglobinemia.
- That's a great case.
What was the inducer? Tox screen was negative.
But he was on a farm.
So I'm getting the local health authorities to check it out.
- Are you taking care of Tina-Marie? - Yes.
My mom watches them and she said they announced they're broadcasting live and she's dying.
- No, that is not happening.
- She's not dying? No, and they're not broadcasting from here.
Dr.
Greene said no way.
She and my aunt are by the TV with their credit cards.
Talking about those televangelists? - Yeah, Dr.
Emmet and Tina-Marie.
- They have some clout.
I just got a call from Administration saying we're to let them do a broadcast.
Adele? Hey, Adele! Hey, you're tough to catch up to.
- Josh is my patient.
- I read the report.
You know the situation with his mother.
Sure, but there's been a change in the environment.
His mother now lives with her aunt.
We feel that the aunt can take care of Josh.
- He's addicted to methadone.
- I know his medical history.
But my obligation is to return the child.
- Can you hold this? - Yeah.
We'll carefully monitor his progress.
We understand the situation.
As long as he needs methadone, she'll steal it from him.
I'm sorry.
He has to go home.
Okay, how is the aunt gonna pay for the meds? - He's on Medicaid.
- Okay.
Some of the meds are formulary.
I'll have to fill out an authorization.
- Dr.
Ross- - We examine him and give him everything.
How long is this gonna take? Just long enough to fill out some forms.
- Here we go.
Come on.
- Okay.
Okay, come here.
- I got him.
- All right.
Just give me a second to lock up my car.
Here we go.
- Come on.
Got it? - Got everything.
Okay, here we go.
All right, Josh.
Deep breaths for me.
I'm hearing basilar rales on the left.
Get a CBC, blood culture and a chest film.
- Why? What's wrong? - Could be pneumonia.
- Pneumonia? - Want to hear for yourself? What do I say to the mother? How long does he have to stay? Four hours for test results.
If it is, we'll put him on IV antibiotics.
That means he'll spend the night? Could be, yeah.
Okay.
All right.
Kid looks pretty good.
No fever.
You sure you heard rales? There's no rales.
I'm keeping him.
What's going on? We got a 7-month-old baby admitted twice for withdrawal.
I'm not sending him home to be a methadone source for his mother.
- Can't Child Services take care of it? - I'll do an ultrarapid detox and end his addiction today.
- Ultrarapid? What does that mean? - Quick withdrawal under deep sedation.
He's going cold turkey right here? I spoke to a pediatric anesthesiologist.
I know the procedure.
It can be done safely.
How long will it take? You're gonna hide him here for 12 hours? I don't have a choice.
- You can't do it alone.
- Yes, I can.
- No, you can't.
- Don't put anything at risk.
Yeah.
Well, if we get caught we'll both help each other through real-estate school.
Put him on cardiac monitor and pulse ox.
I'll do an arterial line.
We'll need a ventilator.
Okay? Okay.
Here's the second dose.
Let's run that over five minutes.
How you doing? I feel a bit tired, but otherwise I'm okay.
Are my mom and dad around? Yeah.
They went to go make some phone calls.
I can go get them.
No hurry.
How is your patient? Aside from his color? He's improving.
Good call, John.
Gotta figure out its cause.
See who else is at risk.
I've heard a lot about you from Anna.
- Really? - Yeah.
She told me you've become close friends.
I heard about your cousin.
I'm sure she was a big help.
She told you about that? - You know Anna doesn't keep secrets.
- Yeah.
I don't really see how that concerns you, though.
Well, what she's learned about drug addiction she had the misfortune to learn through me, John.
I know it's private.
I meant no offense.
No, forget it.
- Dr.
Romano.
- Peter.
You're a "dried fruits and nuts" guy.
Nothing healthy here.
I was looking for you.
You found me.
- You don't mind if I eat? - No.
So, what's up? What Elizabeth and I do in our personal lives should not impact her career.
In your personal lives.
What's that? You saw us in the lockers, then hinted that she won't receive sponsorship next year.
Now, we both know that's not right.
Look, I had no idea you and Lizzie were an item.
I swear I didn't.
But don't worry.
I mean, I'm happy for you.
So you didn't see us? No.
But you're having an affair.
Terrific.
It puts things in perspective.
Hey.
Congratulations.
Excellent choice.
- Need help? - No, I got it.
- Who needs a vent? - Nobody.
Respiratory called.
They need it upstairs.
Mr.
Chambliss.
Dr.
Chambliss.
I want you to know I think this broadcast is inappropriate.
I assure you, as I did Public Affairs, you'll be referred to positively.
Dr.
Del Amico? Stay in the room during the broadcast and if you feel Mrs.
Chambliss' health is being compromised, call me.
No problem.
A little help here! I got it.
What do we got? Cylla Voliotis, age 12.
Blunt trauma to the right eye, concussion, possible facial fracture.
Let's go to Trauma 1.
- You the mother? - No, Phys Ed teacher.
She was running and hit a lamppost.
The school call the mother? They're trying, but I have an emergency consent form.
Good.
Good.
Okay, nice and easy.
On my count.
One, two, three - It hurts so bad! - I know.
Don't worry.
- We'll take care of you.
- Morphine? Let's start with four.
- Partially extruded globe.
- She have vision? - Can you see, darling? - It's all red and blurry.
- How many fingers am I holding up? - Three.
Good.
Good.
Iris and lens are intact.
No vitreous hemorrhage or detached retina.
Okay.
Let's get 1 percent lidocaine.
With that, Betadine and a Steri-Drape.
No Ophtho consult? No, we've done this before.
All right, he's out.
Let's tube him.
How do we know when withdrawal's complete? After 12 hours of the Narcan blocking the narcotic about a 98 percent success rate.
When he wakes up, he shouldn't have withdrawal symptoms.
I'm in.
Pulse ox 98.
BP? Good breath.
Heart rate? Let him settle down a bit.
How's it going, Cylla? I'm scared.
Alcaine's in.
- You feel that? - What? I think we're about ready to go.
So, what kind of music do you like? Spice Girls.
Who's your favorite Spice? Yosh, methyl cellulose.
What is it? Sporty Spice, All Spice Cylla Spice? No, I like Posh.
Okay, good.
I need you just to hold still.
Okay, hold still.
- Sterile applicator.
- Here you go.
I'm just gonna evert the lashes.
There.
I can see a little better.
Yosh, eye shield.
It's gonna be a little blurry for a while and a little sore.
Let me know when her parents arrive.
She'll need an orbital CT and Ophtho can see her.
Praise the Lord, yes! Praise him for his blessing prompted by your prayers and offerings.
It is only by your faith that I will survive my ordeal.
Only hours ago when pain coursed through me Emmet Emmet, you tell them.
Brothers and sisters, the Lord has put another trial before us.
Tina-Marie just learned from this lovely lady- No, she's not a movie star.
This is Tina-Marie's doctor.
Will you tell us the nature of her illness? She has cellulitis and renal insufficiency.
And what does that mean? She has a problem with her kidneys.
- But she will survive? - Yes.
Yes! She will survive through the power of Christ Jesus and by your prayers and offerings.
Emmet, Emmet, Emmet! I can feel the power of prayer right now! I can feel it! It has started! We all feel it, honey.
Do you feel it, doctor? - No.
- Well, come on.
Here, take Tina-Marie's hand.
We will have a prayer interface.
People are watching and waiting for you, honey.
Yes? Feel the power of the love that courses through us.
God, through you will save my life! Kerry? Got another set of x-rays.
Let's have a look.
Is there a name on these? They're mine.
These are much better images.
- Did you look at these? - No.
Well, it looks clean.
- Why'd you order them? Cough? Fever? - Yeah.
- Night sweats? - No, but I have trouble sleeping.
Forgetfulness? Those slides, I put in your mailbox.
But yeah, there's been forgetfulness.
I want you to know something.
Whatever your status, even if you have a measurable viral count no one's going to overreact.
There's going to be a job for you here.
We should draw some blood.
- He didn't see us? - That's what he claims.
I misread him, and you told him about us.
I told him that nothing we do should affect your standing here.
You got heavy with him? Yeah.
Maybe I should've kept my mouth shut.
Taking up my cause was very gallant of you, Peter.
But it seems we've gone public.
- Good breath sounds bilaterally.
- Heart rate's down to 100.
- Pulse ox 99.
- He's stable.
Start a second line and be ready before we give him the Narcan.
- Are there gonna be side effects? - It'll make him hypertensive.
We have Nipride, but no esmolol.
I want to have both ready on drips.
- I'll go get them.
- No.
I'll do it.
Kerry Weaver might wonder why you're here after your shift.
Suction.
Lizzie, can you retract distally? Good.
I got the room I need.
Now we can all settle back.
Shirley, let me ask you something.
Suppose you asked someone on a date- I'm married.
Hypothetically.
It's a long procedure.
You ask them out and they beg off, claiming they don't get involved with work colleagues.
- Got some oozing.
- Got it.
Then you find out they're having an affair with a colleague.
Now, why do you suppose they lied? The colleague is married.
Married person's response.
But say he's not married.
They didn't want to offend an overblown ego.
It's a thought.
But suppose this person made up that story about keeping sex and work separate so they could continue playing the field.
That's absurd.
Clamp again.
Right here.
I don't know.
Shirley? I agree.
They're probably still shopping around.
- Your shift ended hours ago.
- I got involved.
- Esmolol? - Teenager with a tachy arrhythmia.
- How about adenosine? - I already tried it.
Lasted for a few seconds.
It's under control.
Dr.
Carter, I just got this fax for you.
This is the explanation for the methemoglobinemia.
Really? It's from a local health service near the farm.
"Ground water from several areas has been found to have heavy nitrite concentration from inorganic waste contamination.
" Test the parents.
They might be borderline.
Yeah.
I did that already.
I'm just waiting on the test results.
- Are the labs back on Chambliss? - Here.
Thank you.
Pedes case? I'll put it in my study.
Sorry.
It's a repeat glucose on the televangelist.
- I heard you look great on TV.
- Someone saw me? - The nurses had it on in the lounge.
- What a nightmare! Total frauds.
Not serious? But I phoned in a big pledge! The woman used her disease to milk money out of poor people who probably believe all of it.
It's a living.
At least they're not practicing law or polluting streams, selling insurance What's the deal on getting a genuine Philly cheese steak? I've looked.
They don't exist.
Italian? I'm on a substantial per diem.
And I'm on call.
Chinese? How about a candlelit dinner in the lounge? I'd love to.
Jeanie, could I see you? Sure, Kerry.
You can go.
I'll bandage him.
Thanks, Yosh.
I got your labs back.
I'm very happy to say it's all good news.
Your viral load remains non-detectable your white count's normal and you're not even anemic.
Guess I was worked up over nothing.
I can understand.
But I took responsibility for monitoring your health.
You shouldn't be on your own looking at x-rays.
Yeah, you're right.
That won't happen again.
What about the forgetfulness? You complained of sleeplessness.
I haven't slept much this month.
- Are you taking anything? - Lately I've been taking Halcion.
Which could explain Okay.
The fact is, Jeanie- I mean, you've had such a rough time.
With Al moving away and Scotty That alone could explain your symptoms.
Yeah, you're right.
If you ever wanna talk Thanks, Kerry.
I'd like that.
Good.
Figures are 10 percent above projections.
I think there'll be real cassette sales.
Well, what about next time? Do I die on the TV? Don't make stupid jokes.
Your blood sugar's still elevated.
I need to give you more insulin.
I'm gonna make some phone calls, sweetie.
How often do you test your blood sugar at home? What's that you're supposed to do? Four times a day? I don't know.
To prevent complications, yes.
Well, what kind of complications? Blindness, heart attack, loss of peripheral circulation.
Those are all good prayer vigils.
I'm not joking.
Take responsibility for your health.
Take your problems seriously.
Honey, my problems are all I got.
You wouldn't make a living without them.
Well, I sure as heck wouldn't have Emmet.
You're a lovely thing.
- Are you married? - No.
Emmet and I were married when we were in high school.
Oh, we were crazy in love.
You'd never know it now, would you? It's not for me to make a judgment about that.
I'll tell you one thing.
Emmet won't leave me.
Ever.
God has given me the way to keep him close.
He may not love me.
But he loves the way caring for me makes him look.
I wouldn't be in a marriage without love.
Oh, honey, everyone thinks that.
But things change.
And you make do.
So be careful.
Thank you.
So I suppose the Coq d'Or's a bit dressy? Yeah.
But actually, I didn't make reservations there.
- Our date's off? - No, no.
We're going to the Velvet Lounge.
That's fantastic.
- They'll look at us like we're crazy.
- You know that doesn't bother me.
Wish I could say the same.
Look, I can't change what I am any more than you can.
Whatever feelings I have for you are based on who you are not what I want you to be.
Elizabeth, you're not from here.
I mean, you didn't grow up the way I did.
I wish I could say my feelings about your skin color would disappear.
But it doesn't work like that.
Do you understand? Yes.
But I don't want to subject you to something you're not ready for.
You know, I've never met anybody that makes me laugh or blush, or whatever, the way you do.
I'm trying to work through this.
You gotta trust me, all right? Come on, let's go to the Velvet Lounge.
Hey.
Philly cheese steaks.
I found them here.
And they deliver.
Can you believe that? Want one? More than enough.
No, thanks.
Oh, come on! You get a free angioplasty with a small order.
Free quadruple bypass with the dinner special? No? I was wondering.
Maybe you'd like to join Anna and I for dinner sometime.
You really want an ally.
No.
It's about your friendship with her.
I don't want her to cut herself off from people she likes.
Make it easier to go back to you.
Am I hearing jealousy? Maybe once.
Not now.
I just think you're trouble.
Maybe I'm wrong.
I sort of hope I am.
But that's what I think.
I might laugh at your jokes, never giving an indication of how I feel.
But I wanted you to know that.
Enjoy your dinner.
Hey, Mark.
I've been thinking.
This storage area off the hallway could be made a pediatric exam room.
- The janitor's closet? - Children's beds are small.
We could hang the IV bags on the hooks used for brooms.
This is a joke.
Maybe I'm facing reality.
You're obviously behind the idea.
You gave Rosher a grand tour.
He was very impressed at how we handle our Pedes cases.
Doug's your friend.
You think Rosher's report will get him an Attending position.
I appreciate loyalty, but not at the expense of the ER.
That has nothing to do with it.
I don't believe a Pedes unit or Attending is a big improvement.
Dr.
Greene, Jeanie wants you to sign off on a suture job.
Will you go on record with that? Absolutely.
When the time's right.
Where is she? - Pulse ox 89.
- What's going on? Decreased breath on the left.
A collapsed lung? Should I get a portable x-ray? Can't be.
Pressure's not that high.
I'll give him 100 percent oxygen.
- Could be a mucus plug.
- I'll get a suction catheter.
Looks good.
- Infected abrasion? - Here.
She cleaned it good.
I'll change it when you come back.
Sure.
On Thursday.
- It's secretions.
Hook up the vent.
- Pulse ox 98.
What the hell is this? This boy is my patient- Ketamine? What're you doing? An ultrarapid detox.
Everything's under control.
Like hell it is.
Is this baby even a registered patient? - He- - Is he on the board? If you'll just let me explain- You don't have consent, do you? You've got an intubated kid under deep sedation? - It's under control.
- We gotta move this kid.
- Hear me out- - No.
- BP 190/100.
- Nipride, 0.
3 mcgs per kilo - per minute- - Gina, bag him.
- Let's get to the PICU.
- We can do it right here.
- His chart? - I don't have one.
Is this how you practice medicine? - I wrote everything on that paper.
- Oh, that's great.
Inga, call the PICU.
Critical patient coming up.
- I need a name.
- Name? - We don't have to.
- What's the name? - Josh McNeal.
- Baby McNeal.
About six months old.
Ketamine drip.
Intubated.
What's going on? I found Doug in Exam 4, detoxing this baby.
- What?! - I found him by accident.
- Did you know? - I was helping him.
Helping him?! - He was stable, Kerry.
- This is a violation of every policy.
- Bed's ready.
- Tell them I'm bringing him up! - I'm going too.
- You're damn right! You're gonna explain to the Administration and the Executive Committee! Let's go! You lied to me.
You looked me in the face and lied.