ER s04e22 Episode Script
A Hole in the Heart
ER Previously on ER Peter! Oh, hi, Lizzie.
I think it's about time you and I had a little sit-down.
Is there a problem? - Am I hearing jealousy? - I just that I think you're trouble.
- What about his heroin addiction? - It wasn't heroin.
It was painkillers.
I'll do an ultrarapid detox and end his addiction today.
You're gonna keep him hiden here for 12 hours? I found Doug in Exam 4, detoxing this baby.
What! You're gonna explain this to the Administration and the Executive Committee! You lied to me, Doug.
You looked me right in the face and lied.
"A Hole In The Heart" That's not fair.
You wouldn't have let me do it.
You couldn't monitor him! EKG, pulse ox, end-tidal CO-2, and invasive BP.
- You never got consent.
- From his methadone-chugging mom? DCFS would have followed through if you'd left it alone.
His development is already stunted.
Been expecting you.
Your desk clerk just called.
- Admit orders? - None.
Here's everything you need right there.
Start him on labetalol titrate 0.
5 q five minutes to a diastolic of 60.
Alexander Babcock, pediatric anesthesiologist.
Kerry Weaver, Acting Chief of ER.
This is Josh McNeal, 7 months old- The boy was born addicted to heroin.
I put him on an ultrarapid detox.
- A couple have been done in the US.
- It's still an experimental procedure.
BP's not bad, 150/90.
This boy needs to be stabilized and put back on methadone until Administration and Legal reviews the case.
- What did you use to induce? - Ketamine and Narcan.
- Propofol's better.
- ER didn't have it.
But we got it up here.
D/C the ketamine and three mgs of propofol.
Then 150 mics per kilo per minute.
You're continuing with this? The approach seems medically reasonable.
You cannot perform procedures on children without permission.
It seems in the best interest of the child to complete what's been started.
- Who's the follow-through? - I am.
I'm off work till tomorrow, so I'll stay.
Your actions are totally irresponsible.
You've broken every rule and regulation we have in the ER.
What happens here won't change that.
I want him to have a shot at life.
I don't care about rules.
I hope you also don't care about being an ER Pediatric Attending.
You've given up any chance of that.
- Mark, 7:00.
- What? Seven o'clock.
Rise and shine.
Did you hear from the PICU about that baby? Haleh just went off duty.
She didn't mention anything.
Am I supposed to wake up Dr.
Weaver? - She stayed too? - Snoozing in Exam 4.
Let her sleep.
Come on, girls.
Sweep, sweep, sweep! - Randi's in my way! - I'm supposed to be here! - Curling? - We were inspired by Nagano.
Three years and nine months left till Salt Lake City.
These crazy white folk.
You having a slumber party? No.
Did you hear anything from Doug? No.
Is that why you spent the night? I was nostalgic for my residency.
I thought Carol was here.
She is.
But she's on a break.
There's no new patients, why'd you wake me? - Haleh said 7:00.
- That was for Dr.
Weaver.
Forget it.
I'll just get some breakfast.
Can you call Anspaugh and find out his schedule? - I need a meeting with him soon.
- Okay.
- You didn't answer me.
- No idea how they got their names.
The drinks go down so smoothly at the Velvet Lounge.
- I wouldn't know that.
- That's what this is about.
I was drinking and you weren't.
- You know I don't drink.
- You think I drink too much.
Damn it, we missed the 7: 10.
We can get the next one and cross over at Madison.
No, I can't.
I've gotta go to Carla's and pick up Reece for daycare.
You always like this after a night out? What? We saw the whole show.
We didn't need to stay for another set.
- I thought we were having a good time.
- We were.
Until I made that song request.
The look on your face There's some places that you go to listen to the music, just listen.
So it's not like the pub where you can play darts nobody cares if you drink too much or put something stupid on the jukebox.
I'm saying in a place like that, it wasn't cool.
Well, if you ask me, being cool seems somewhat limiting.
You taking this one? Yes, I think I will.
I'll see you in there? - Yeah.
- Okay.
Why didn't you wake me? I have a meeting with Anspaugh.
We woke up Dr.
Greene by mistake.
We just got two bounce-back migraines.
One's mine.
A fractured clavicle, complaining of coldness to his hand.
A suicidal guy with intention marks to his left wrist.
Who else is on? Del Amico, Jeanie and Carter are coming.
In other words, they're late.
I'm the only one here.
Why is that? Thank you, Lydia.
I'll be right out.
- I thought you might want a refill.
- I just got one.
Thanks.
- I hear it's supposed to rain.
- You want to talk about last night? - It's very serious what Doug did.
- You mean what we did, don't you? It's the nature of your job to assist a doctor when they ask you.
I was there because I wanted to be.
Not because Doug asked me.
I'm sure you were.
Doug can be pretty passionate about these kids.
Oh, give me a little credit, Mark.
You think I'm a fresh-faced nursing student under the doctor's spell? I'm only saying that Legal and Administration are going over every detail of this case.
I'd hate to see it reflect on your record.
So you're saying I should fudge my involvement? Tell the truth.
Tell them you were assisting a doctor.
I insisted on being there because Doug was working in the best interest of the patient.
And that's my job.
Every bit as much as it is his.
I gotta get back.
We had our noses pressed on the glass.
The tracks moved right beneath us.
- You've never done that before? - No.
All you have to do is ask.
- Hi.
- John.
Have you ever ridden in the front car of the El? With the driver? - I don't think so.
- Anna and Dr.
Rosher just did.
Max.
Please.
Max.
Max.
See you.
- That sounds exciting.
- Yeah.
Max just asked the guy if we could.
- Pretty clever.
- Well, thank you, John.
You'll give me that one.
But maybe not the next.
I gotta go pry a kid's leg out of a shopping cart.
Call Maintenance.
Bolt cutters'll do it.
Right.
Does feel cold.
That's what I'm saying.
It's the damnedest feeling.
Nails are cyanotic, cap refill's poor and he barely has a radial pulse.
Doesn't sound good.
I want to get an ultrasound and an angiogram to rule out a blood clot which affects blood flow to your hand.
Whatever you need to do.
I've got great insurance.
You get excellent care here even without it.
- Can I talk to you? - Of course.
Can you get consent from Mr.
Wass and schedule him? Okay.
I have a call into Anspaugh's office to talk about Doug.
- I'm seeing him in a few minutes.
- We need to be involved.
My meeting's about something that's been on his calendar for a while.
- I'll set up another for us two.
- Let me know the time.
Don't worry, I will.
Send home the rule-out appy in 3 with the diagnosis of constipation.
Is there a good trauma on its way? No.
But this letter came down for you from Dr.
Romano.
He's a weird little dude, isn't he? - Did he drop this off himself? - No.
It was his secretary, I think.
Where is he now, do you know? It's not my job to keep track of stuff like that.
On our way in he drank all of his juice without spilling.
Go play.
There you go.
Is he pretty responsive to you these days? As responsive as a one-year-old can be.
Why? Sometimes it's hard to get his attention.
Have you had his hearing checked? - What? - It's not a problem.
Just things we notice.
Reece.
Reece.
Come here, man.
Come here.
Come here.
Oh.
I know.
I know.
He seems pretty responsive to me.
He probably gets distracted by all the other kids.
Listen, Carla's gonna pick him up around 4, okay? Sure.
That's fine, Dr.
Benton.
Who's hiding? Who's hiding? Hi, Reece.
Who are you playing with today, huh? I just feel so ridiculous.
I never really meant to kill myself.
So it wasn't just an accident? You see, my wife and I, we had a fight, you know? And So I went out to my workshop I brought a glass of orange juice with me and I dropped the glass and when it broke, there was a shard lying there and I just I was just so angry.
- So it was impulsive.
- It was stupid, is what it was.
I worried my wife.
Although it's nice to know she cares.
- This is Jeanie Boulet.
- I'm a Physician's Assistant.
I'll suture up your cuts.
Shouldn't be more than a few stitches.
A Psychiatric Resident will speak to you.
Oh, listen, I'm fine.
Okay? This was just a mistake.
I really don't need that.
We're sure it was.
But it's required in a case like this.
Oh, man.
Give it more time.
Kerry.
Hi.
We're finishing up.
Doug called an emergency meeting to fill us in on Josh McNeal.
I'm familiar with it.
Because of the circumstances, I wanted to bring everyone up to speed.
Doug has admitted to stepping over the line.
But he prevented the baby from going home.
Anesthesia and Pediatrics needed to be involved.
And he needed to get the mother's consent.
He wouldn't have gotten it if it meant losing her methadone.
I knew Max was doing a feasibility study on ER Pediatrics.
I didn't want to jeopardize that.
I think it's still the best thing for County General.
Doug, I don't want to minimize the ramifications of this.
- But thank you for coming forward.
- Sure.
If you'll excuse me, I want to get to PICU.
Doug, thanks.
We'll talk.
Don, I don't think I need to tell you that Doug's actions violated every policy we have regarding patient care.
I know.
And there'll be a full review and QA.
It may not go so well for him.
But I must say he's certainly there for his patients.
I'm sorry this has eaten into our time.
What is it that you wanted to talk to me about? Well, as you know, when David Morgenstern had his Ml last fall I took over as Acting Chief of Emergency Medicine.
And you've done a fine job with the exception of that little Ellis West/Synergix fiasco.
With Dr.
Morgenstern having resigned, it seems appropriate for me to be Chief of ER.
The department is running well, and we owe you many thanks for your efforts.
Well, I think everyone's responded to my authority.
So it's just a simple change in title.
I'm glad you'd like to be considered for the position.
We will be doing a national search for the best candidate.
But I'm happy you're throwing your hat in the ring.
- A national search? - County policy, as I'm sure you know.
Excuse me.
Don Anspaugh.
How's he doing? Pretty stable.
Turned off the propofol a half-hour ago.
When's Doug gonna extubate? I figured I'd give him a couple more minutes.
Hey.
I was in the middle of a pretty decent dream.
- Was I there? - Big-time.
Did I do the right thing? Yeah.
You did.
Even if we both get fired for it? That would just be icing on the cake.
Kit, you ready to extubate him? He's breathing spontaneously.
Vitals? Afebrile, BP's stable 90/70.
Suction cath.
Okay, buddy.
Prove us right.
Get ready to bag him.
I'll do it.
Here we go.
Pulse ox? Holding steady.
98 percent.
Do you think he's gonna make it? Too soon to tell.
- Shirley, I'm looking for Dr.
Romano.
- He's not here.
- Do you have his schedule? - He's not here.
He went to some head-and-neck conference in Costa Rica.
- He doesn't do head-and-neck.
- Maybe he wants to learn.
Maybe he's just playing golf.
- So when's he due back? - Teresa does the travel scheduling.
Lovely.
Where can I find her? Right here.
Except she's on a break.
I wanted to inform you on a patient.
He's a 7-month-old boy, addicted to heroin.
- His mom stole his methadone.
- You know? Doug briefed us with your Chief and some of the Pedes.
There was a meeting? Kerry, I'm sure, can give you the highlights.
Anspaugh seemed calm.
But, man, if that had happened at CHoP Doug would've been fired.
Anyway, I gotta go to chart hell.
- You seen Kerry? - No.
Sorry.
We're concerned you get angry in a self-destructive way.
Look, I know I should handle it better.
Okay? And I will.
But I really don't want to stay overnight.
I'm not a crazy person.
This was just stupid.
I need to talk to you for a minute, Dr.
Meyers.
Excuse us a moment.
- He isn't staying? - I don't have a reason to keep him.
I pulled up his old records.
He's been here 3 times in the past year.
Migraines, abdominal pain, back pain.
- Think he's drug-seeking? - He wants help.
Depression is not grounds for admission.
- Hell, that'd be half the city.
- He's released? He's responsive, doesn't seem suicidal or psychotic and he's willing to come in for a follow-up.
I wish we could do more.
He's fighting with his wife, job isn't good- I know; half the city.
- Have you seen Dr.
Weaver? - Usually she's everywhere.
Do you think it's too late to reconsider my ER residency? Oh, you getting bored? Oh, I just cleaned out an old guy's ears.
And dislodging a 5-year-old from a shopping cart- - Any unsickly patient is good.
- Stop complaining.
- By 9:00, I'd been puked on twice.
- I also did two bowel disimpactions.
Do you want to answer the phones instead? Why don't you take the coma patient in 4.
- Paramedics have a double trauma.
- Double? Two Elvis impersonators crashed into Lake Michigan.
Cool.
- Ooh.
Maybe, Dr.
Greene, I could - No, take the coma patient.
Jeanie, Anna how about getting a handle on the "Elvi.
" We got your Over-the-Hill Elvis.
Here's Junior Elvis.
Parachuted out of a plane to land on a pier.
Lines got tangled.
Lake landing.
But he's up there picking his pimples.
- Can't skydive to save his life.
- At least I can do Elvis.
That's more than I can say for you.
I was doing Elvis before you was even born.
- I'll be doing him after you're dead.
- Shall we? You need anticoagulation therapy in order to prevent any further clotting.
- In the hospital? - Not necessarily.
There's a fairly new drug, enoxaparin which you inject under the skin in your abdomen twice a day.
My wife could do that.
You're an excellent candidate for it.
Or you'd have to stay here for a few days- I don't want to do that.
I'll take the drug.
Okay, good.
Kerry, I need to talk to you now.
Sure.
Nurse Jarvik will discharge you.
- Thanks.
- You're welcome.
What do you got? Two jokers fell in the lake out of an airplane or something.
That Doug Ross meeting happened this morning.
- It sure did.
- I asked specifically to be notified.
Mark, nobody told me either.
I just walked in on it.
You could've mentioned it so I didn't have to hear about it third-hand.
- I had patients.
Give the bullet.
- I already did.
Give it again.
- A Junior Elvis- - Jeanie, we've got this.
Help Anna.
Tell that wanna-be his "Heartbreak Hotel" sucks the big one.
Oriented and alert.
Vitals normal.
BP 120/70.
Cap refill's fine.
BP's high.
180/120.
- Good luck.
- Better here than in there.
Those two make the Elvises sound like Boy Scouts.
- Spin a crit and dip a urine.
- Want a Chem-7? Sure.
- Why didn't they tell us? - Why don't you ask your pal Doug? - Do you think there'll be an inquiry? - Hopefully, Doug will let us know.
Why're you angry at me? I didn't detox a baby and hide it.
But giving him an inch, he gets away with a mile.
- So this is my fault? - It's not a question of fault.
It's about style.
You close your eyes and hope things will disappear.
Here.
When I try to come down firmly, you tell me to pull back you fight me and it'll disappear.
It's not disappearing this time, is it? It's not the time or place to discuss this.
Chuny, let's repeat a BP, please.
- Mrs.
Lang, this is Dr.
Carter.
- How do you do, Mrs.
Lang? I've just been going over your chart.
- I see your husband has- - I couldn't wake Bill up this morning.
He was diagnosed 14 months ago with brainstem glioblastoma.
They tried to do radiation therapy.
But that didn't work.
He's had some visual disturbances and some paralysis.
But we were not expecting this.
We'll do everything that we can.
Let's order an MRl with gadolinium.
Get in a Neurosurgery consult and the Oncology Fellow on call.
I hope it's okay that we opened the window.
Bill, he just loves the smell of the rain.
That's fine, Mrs.
Lang.
Last time I complain about kids in shopping carts.
- What? - Never mind.
- Oh, hi, Adele.
- Hey, Carol.
This is Vicki McNeal.
This is Josh McNeal's mother.
Baby Josh, right.
- Hi.
- She'd like to see her son.
- Thanks.
- Dr.
Benton.
- Randi, an audiologist is gonna call.
- An "audi"- what? Hearing tests.
Write it down.
But we've got an MVA coming in.
A Mazda versus a milk truck.
I'm just signing charts.
But I can't find Dr.
Corday.
Upstairs says she's checking out Costa Rica.
- What? - That's what I said.
About the MVA? Oh, damn it.
- Dumar, what do we have? - Sam Wiser, 32.
Head-on TC.
Head, neck and abdominal trauma.
- Did she ask about consent? - I don't know what Adele told her.
Ms.
McNeal.
Is he gonna be all right? Well, he's stable.
His blood pressure's holding steady.
He's sleepy.
But it's expected after a prolonged sedation and intubation.
Intubation? A tube down his throat to help him breathe.
He was asleep while they did it.
I explained to Vicki about the ultrarapid detox.
How the drugs'll be out of his system.
So he'll be able to sit up like other kids.
We believe he'll be able to catch up.
The procedure went well.
We just have to wait and see.
So what I wanted to know then, Dr.
Ross, is could you do the same thing for me? I'm gonna kill you! Why? You offered.
You get my patty melt? Yes, I got your patty melt.
Hey, will you help this gentleman? He's looking for Dr.
Weaver.
Sir? - Can I help you? - Yes.
I'm looking for Dr.
Weaver.
Dr.
Weaver? - Mr.
Wass, what are you doing back? - I couldn't get the enoxaparin.
It's $500.
My insurance won't cover it.
They'll only cover something called heparin or Coumadin.
- Coumadin.
- I should be on that? You need to be hospitalized for those.
I'll call the insurance company.
Can you get Mr.
Wass' insurance information and put a call in, please? Carol, you know, I had a meeting with Dr.
Anspaugh this morning.
There will be an executive committee review of the Josh McNeal case.
Doug told me.
It'd be in your best interest to document your participation while it's still fresh.
Oh, that experience isn't going away anytime soon.
You should hope neither you nor Doug Ross is either.
Dr.
Weaver? Mr.
Wass' insurance? Thank you.
Yeah, Dr.
Weaver.
No.
No, no, no.
I don't want the claims department.
I need a medical supervisor.
Mrs.
Lang? MRl is backed up.
It'll be a little while longer.
I've got Nurse Hathaway checking.
He is gonna wake up, isn't he? His doctors thought we had longer.
We really won't know anything until we get those test results back.
Is there a phone here? I want to call my daughter.
She's a freshman in college.
Tulane Drama School.
She didn't want to go because of her dad.
But Bill, he insisted.
He said that it was enough that his life was being put on hold.
I don't know.
Maybe we made a mistake.
Looks like an avocado.
Dr.
Corday.
Sorry I'm late.
You were on trauma call when Mr.
Wiser was brought in.
Dr.
Benton was kind enough to cover while I was away.
You've reviewed the chart? - Avulsed gallbladder.
- Can I get some suction here, please? Let's say you find a significant pancreatic injury.
Crushed duodenum and common bile duct.
What are you going to do? A Whipple, which as you know I performed solo back in England prior to my fellowship.
Yes.
I think I did know that.
Speaking of fellowships, can I ask you about the possibility of sponsorship for next year.
What about Dr.
Romano? It seems Dr.
Romano doesn't wish to continue with me.
What? He served me notice today.
And he's unavailable at some head- and-neck conference in Costa Rica.
It's too late to arrange another fellowship at County General.
We're past application deadlines.
I was hoping for individual consideration since I've spent a year here.
The committee always seems to frown on that.
- You really want to stay in the US? - Very much so, yes.
If it's staying in America, you could marry an American.
- Shirley.
- Sorry, Dr.
Anspaugh.
Your guidelines are wrong.
He needs anticoagulation therapy.
And he doesn't need to be admitted.
- Dr.
Weaver.
- What is it? The renal failure guy's here.
Okay.
I'll be there when I can.
You know, I would like to get your name.
Rufhauer? Rufhauer.
Louis Palmieri, 84.
End-stage renal failure.
Full cardiopulmonary arrest.
His femoral dialysis catheter had been disconnected.
- Sheets were drenched with blood.
- Will he be okay? Would you stand back please? No pulse or heart sounds.
Intubated.
Two amps epi, two of atropine.
Reattached saline to the catheter, two liters.
That does it.
- No pulse? - No.
Amp of bicarb and a high-dose epi, five milligrams.
- Please be okay, Louis, huh? - No heart sounds.
He's PEA.
Spin a crit and four units O-neg.
- Try a transthoracic pacemaker? - Yes.
- What? - Getting his heart going.
- Turn up the gain.
- You a relative? - Not exactly.
- It's not capturing.
- You did come with him.
- Yeah.
I drop by his house every week.
Mrs.
Lang? Your husband's MRl results are done.
The tumor is blocking his It's a blockage that's increasing intracranial pressure.
- And that's causing the coma? - Yes.
So can it be unblocked? Yes.
A neurosurgeon can perform a ventriculostomy.
So Bill could come out of this? He could.
The outcome is problematic.
Your husband would have very little time.
And it may cause him a great deal of pain.
He would most likely die of respiratory failure.
But Bill would wake up? I mean, I could talk to him again and he could hear me? Yes.
Or he could stay the way he is now and die peacefully.
- She wants to handle the funeral? - He has no family.
- What's her relationship? - Friend.
- She looks like a hooker.
- She is.
She's been "attending" him twice a week.
- Did you say he had a Foley catheter? - Yes.
- Excuse me, Miss? - Myra.
Miss Myra.
I wonder if you could tell me exactly what happened.
I've been seeing Mr.
Palmieri twice a week for the past couple of years.
It wasn't a lot of money.
But then I was only providing manual relief.
But today my bracelet here got caught on that little tube.
When I pulled back, it popped out.
The next thing I know is, there's blood everywhere.
- So I called 911 right away.
- I see.
Dr.
Weaver, some insurance company's on the phone.
I'll be right there.
Excuse me.
I say give her the body.
You were here a little while ago talking to Dr.
Greene.
Yeah.
Have you seen a vial of Percocet? I lost it around the drug lock-up.
No, I haven't.
But I'll keep my eyes open.
- there's always a pile of these.
Now I gotta pore over these.
Went through the last two weeks.
You guys do a lot of kids.
- Elizabeth.
- I haven't much time right now.
- I'm trying to catch Langstaff.
- Langstaff? I've heard she isn't too keen on her Fellow.
Thinking of letting him go.
I want to get a word in.
Well, shouldn't you wait to see if she does let him go? I want to let her know I'm available.
And desperate.
Excuse me? I mean, asking Dr.
Anspaugh in the middle of an operation? - He didn't seem put off.
Why're you? - I'm not put off.
If it's about me hanging you up, I'm sorry.
I appreciate you covering.
I wasn't hung up.
Yeah I would've appreciated a page letting me know about Romano's letter.
Look, I would have discussed it with you.
Romano was my first priority.
That bastard didn't even give me a reason.
He's not required to.
He sponsored you.
I mean, it's his call.
You're taking this in stride.
It's not necessarily about you.
It's very much about me.
You don't know how hard I worked to get here.
- I do know what it takes.
- Then why aren't you being supportive? You're doing it the wrong way.
You're running all over, asking every surgeon to sponsor you.
So, what do you suggest? You haven't checked out other hospitals, other parts of the country.
I've built up relationships here.
Or so I thought.
I'm not saying I want you to leave Chicago.
No.
But you're not passionate about my fight to stay.
- Whatever goes on between us- - Peter.
You ready to scrub on that small bowel infarction? Yes, sir.
Please let me finish.
You understand that admitting the patient- - I need you to sign.
- I'm not working.
- These are from yesterday.
- I'm not working.
Josh McNeal is doing much better.
You didn't tell me about the meeting- No! I mean, your policy is not sound, Dr.
Stork.
It's obscene.
I mean, you're spending 10,000 to save 500! Then so be it! I will admit Mr.
Wass to this hospital! And I look forward to billing you for every damn dime we can possibly spend! - Admit Mr.
Wass.
- Want me to call them? - That'll help.
- I don't know what helps anymore.
- I don't care.
Because I quit.
- What? I quit as Acting Chief of Emergency.
Let somebody else "act.
" Wait.
Why am I the only idiot who's worrying about policy? Doug's got the right idea.
Break the rules if it helps the patient.
Everything else be damned! Where do I get by trying to follow them? - Look, Kerry, wait.
- No! - If anybody needs me, I'm outside.
- Cool.
Hey.
- Hey, Carter.
- Getting some air? - Yeah.
I need it after my last case.
- Yeah.
Me too.
I was just talking to Lydia Wright.
And she mentioned to me that some Percocet's been missing from the drug lock-up.
- That's low, Carter.
- Hey, I'm not accusing anybody.
You're my friend.
I want you to know.
Well, Max is clean.
- Well, maybe he is.
But- - But what? That's what Chase used to say to me.
I gotta get back.
Vitals are stable.
The boy's alert.
You got your next journal article.
Right after they draw and quarter me in front of the committee.
Thank you.
We don't always get results this good up here.
I'm going to go check on the Yezerski kid.
What will happen? Back to his mother? Who knows? I gave her a list of names of doctors who do ultrarapid detox on adults.
But it doesn't change the psychological addiction.
At least she's trying.
Come on, buddy.
- I was just coming to look for you.
- You knocking off already? Going to St.
Mark's to see how their unit's doing.
When you off? - Seven.
- Want to get dinner at Johnny D's? Yeah, sure.
Feeling good about getting through those charts? Yeah, it'll be a week or two before I can get a report out.
If you can stand to have me around that long.
What's your recommendation? What happens when I recommend in favor of an ER Pedes Department is they ask me to run it.
I've always said no.
But this time I could be convinced to say yes.
- You mean stay in Chicago? - Only if you want me to.
Wow.
I hadn't really thought that far ahead.
Heard some Percocet was missing.
Yeah.
I heard that too.
I didn't take it.
I didn't suspect that you did.
You'd be crazy not to.
I didn't want to suspect that you did, anyway.
Don't feel bad about it.
I know I've used up all my free passes with you.
But I'm telling you the truth.
And I'm willing to prove it.
Every day.
It's not that I don't believe you.
- It's just- - Anna? - Labs are back on that Ml.
- Thanks.
I'll be right there.
All right, go.
Be a doctor.
I'll call you later.
Sure.
Where's Mr.
and Mrs.
Lang? Mark signed a transfer to White Memorial.
- Why White Memorial? - Maybe his doctor's there.
- Will they do the ventriculostomy? - She didn't say.
Did you tell her there wasn't much they could do? Just would've liked to know what she chose.
- Why? - Why? I don't know.
Just seems unsettled.
Unfinished.
We never know about people when they leave.
You haven't seen Anna around, have you? No.
- There it goes again.
- What? That car alarm.
It keeps starting up and shutting off, and starting up.
- Annoying.
- It's in the ambulance bay.
I called Security.
But who knows where they ever are? Mark, Kerry, this is the action report on Josh McNeal.
Like maybe why you lied to me? - You didn't understand.
- You didn't give me a chance.
Take it outside.
We got work to do.
If you're no longer Acting Chief, who do I give these budget reviews to? I'll take them.
This kid was more important.
You always have a patient excuse.
I'm willing to go out on a limb.
You took the whole tree with you.
I was trying to support you.
To be the Pedes Attending? You weren't going to support me.
We'll never know now, because you did what you always do.
When you're about to get what you want, you sabotage it.
- Is that what you're so angry about? - I'm not angry.
I'm disappointed.
You like that.
It validates that you're the adult and I'm the screw-up.
You never wanted to grow up.
You like it this way.
We hang out, but you're the boss.
For good reason, based on your actions.
Based on your inability to see me as an equal, Mark.
- Bad enough Kerry stepped up.
- I support her.
On the surface.
Underneath, you resented her.
Like you resent what I did with Josh.
Where's Mark? He needs to sign this.
He and Dr.
Ross are outside "sharing.
" Mr.
Nable? What are you doing here? Mr.
Nable, are you hurt? Are you okay? Come on.
Come with me.
Come on.
I'm so sorry.
Where's all this blood from, Mr.
Nable? Come this way.
I'm gonna check you over.
You just sit down right here.
That's my car.
The alarm's always doing that.
I don't know why.
You drove here? We'll get someone to turn that alarm off for you.
Do you have a remote button? Oh, God.
- There weren't enough bullets.
- All right.
Jeanie, stay with Mr.
Nable.
Just be careful.
- Stick this somewhere.
- Cripes.
And call Security to help Jeanie.
Doug, Mark, come on! The car! Come on! - What is it? - Locked.
- Who's in here? - Can you see anyone? - I can't see.
- Something's in the back seat.
- It's two kids! - I'll break a window! Woman in the front, two kids in the back! Hit the latch! The door won't open! Got it! Jerry! Get us three gurneys, backboards, and head collars! Get some help too! I got a 40-year-old woman.
Gunshot wound to the left neck.
Weak carotid pulse! She's barely breathing! Looks like a GSW to the abdomen.
- What's going on? - Ambulance bay.
- Get those out there.
- I got the flashlight.
- Everyone use blood precaution! - What is it? Get outside and help.
Lydia, call for O-neg.
- How much? -15 units.
- Close us to Trauma, page Surgery.
- Kerry.
- Wait.
- No.
This is the guy.
- What guy? - What happened outside.
Mr.
Nable Okay.
Call Security now.
Move him to Curtain 3.
Post someone at the door.
Yosh? Help Jeanie with this man.
- Jerry, push the gurney closer! - C-collar's secure! - Anything else I can do? - Yes! Help lift her! Watch her head! - Gently! Gently! - All right, we got her! - Get her legs.
I'll support her neck.
- I'm underneath her.
- Supports are in! - Mommy! Where's my mommy?! - It's okay, honey! - Slide her out really slow! Get this side! - Got it! - Weak carotid pulse.
Flat neck veins.
Decent respiratory effort.
Trachea midline.
- I got the backboard! - We'll roll him.
Roll him.
- Nice and easy.
- Slide it.
Let's move him back.
Malik! Give me a hand! Top of the board! On my count.
One! - Go! - Two! Three.
Three.
- Start a line.
- Which one? Little girl.
Good breath sounds on the left.
A few crackles at the right base.
I'm Dr.
Weaver.
We'll take good care of you.
What's your name, sweetie? Amy.
CBC, Chem-20, two lines saline wide open.
Cross for eight.
Not moving much air.
I gotta tube him.
6.
5! - Pulse 120.
- BP's 70/50.
- Suction.
- Got it! - Need O-negative on the rapid infuser.
- I'll get it.
- What's going on? - Guy shot his wife and two kids.
Oh, man! - Damn! - We're going to help you.
Doctors are helping your kids.
We'll tell you as soon as we know anything.
- Elizabeth? - Intubated.
Had a respiratory arrest.
- Where's the wound? - Neck.
BP's 80 palp.
Start dopamine.
Ten mics per kilo per minute.
High-dose Solu-Medrol.
- How much? -50 mgs per kilo over 20 minutes.
Then five per kilo per hour.
Send pre-op labs.
We need X-ray in here for a portable C-spine.
Dr.
Benton, a Jackson Kroopf's on the phone for you.
- Who? - Something about a hearing test.
- I'll call him back.
- Carotid's okay, what about yours? Strong.
It missed the major vessels.
Any sub-q air on your side? No.
Tube went straight in.
Trachea's intact.
What's her name? Husband's name is Nable.
Mrs.
Nable can you squeeze my hand? That was good.
Try again.
- X-ray's here.
Where's Mark? - Next door.
The police are here.
Mr.
Nable needs to be cleared.
In a minute.
Can you find out this boy's name? Be nice to know.
Chest tube, 28 French.
Thora-Seal.
- Two more units on the infuser.
- Getting hard to bag.
- Yeah.
Poor air entry on the left.
- Lost the pulse.
- Asystole.
- Start compressions.
- Not feeling a pulse.
- Bleeding out.
Get a central line kit.
Crack him.
Thoracotomy tray.
Get me a 10 blade.
- We need to know your son's name.
- Is he gonna be all right? They're working on him right now.
I turned the gun There weren't anymore bullets.
- I need a chest tube.
- What are you doing? There's a hemopneumo.
Wound's in the seventh intercostal space.
It may be intra-abdominal.
- May not need chest tube.
- Exam indicates hemopneumo.
She's stable.
Lydia, let's get an x-ray.
I don't think she's too stable.
- Does it hurt anywhere else? - Take my hand, sweetheart.
- Are my mom and my brother okay? - They're taking care of them.
I thought we'd drive here and everything would be okay.
- I know.
- Why did my daddy have a gun? My mom said we'd go with him if he came here to talk to somebody.
It's okay.
I thought we'd just talk to somebody.
- Prime the lines.
- Satinsky.
Suction.
I'll do it.
What do you have? A hole in the heart.
Right ventricle.
Keep your finger on it.
Line's in.
Hook it up.
- Rapid infuser ready.
- I'll occlude, you sew.
Hold compression.
Put your finger on the defect.
Don't stick me.
Chuny, we need more blood.
Okay.
Hold this.
- How is she? - She'll make it.
But her spinal cord is injured.
Taking her to CT now.
- All right, let's move.
- Keep me apprised.
- Did you call the O.
R.
? - Waiting for us.
You're gonna be okay, Amy.
We're going to surgery.
We'll let you know how your family is.
Tell the surgeon to call us when he knows anything.
- How's the boy? - Still working on him.
- Let's call that Psych Resident.
- I did.
- He's coming back in.
- Great.
She was gonna take Amy and Steven with her.
I couldn't let her do that.
He's in V-fib.
Internal paddles.
- What do you need? - Charge to 15.
- Heart's failing.
- Epi's onboard.
- Charging.
- Clear.
Still V-fib.
Again.
- Clear.
- Clear.
- Still in fib.
- Charge to 30.
Carol, intracardiac calcium.
- Clear! - Clear.
He's got a rhythm.
Suture's still holding.
Strong carotid pulse.
His name's Steven.
Call the blood bank.
Have them send up eight units to the O.
R.
- I got it.
- Grab those lines.
Help me bag him.
Stat page the Thoracic surgeon.
Chuny, call the O.
R.
Tell them that we're on our way.
Carol, lidocaine, 1.
5 mgs per kilogram bolus.
- Put him on two mg per kilogram drip.
- Got it.
Malik, get me a gram of Ancef.
And call for platelets and FFP.
- BP's 80 palp.
- Tell Security to hold the elevator.
Secure subclavian and attach CO-2 monitor.
Bag him at 24 a minute.
He's probably acidotic.
Everybody ready? All right, let's get him up.
I think it's about time you and I had a little sit-down.
Is there a problem? - Am I hearing jealousy? - I just that I think you're trouble.
- What about his heroin addiction? - It wasn't heroin.
It was painkillers.
I'll do an ultrarapid detox and end his addiction today.
You're gonna keep him hiden here for 12 hours? I found Doug in Exam 4, detoxing this baby.
What! You're gonna explain this to the Administration and the Executive Committee! You lied to me, Doug.
You looked me right in the face and lied.
"A Hole In The Heart" That's not fair.
You wouldn't have let me do it.
You couldn't monitor him! EKG, pulse ox, end-tidal CO-2, and invasive BP.
- You never got consent.
- From his methadone-chugging mom? DCFS would have followed through if you'd left it alone.
His development is already stunted.
Been expecting you.
Your desk clerk just called.
- Admit orders? - None.
Here's everything you need right there.
Start him on labetalol titrate 0.
5 q five minutes to a diastolic of 60.
Alexander Babcock, pediatric anesthesiologist.
Kerry Weaver, Acting Chief of ER.
This is Josh McNeal, 7 months old- The boy was born addicted to heroin.
I put him on an ultrarapid detox.
- A couple have been done in the US.
- It's still an experimental procedure.
BP's not bad, 150/90.
This boy needs to be stabilized and put back on methadone until Administration and Legal reviews the case.
- What did you use to induce? - Ketamine and Narcan.
- Propofol's better.
- ER didn't have it.
But we got it up here.
D/C the ketamine and three mgs of propofol.
Then 150 mics per kilo per minute.
You're continuing with this? The approach seems medically reasonable.
You cannot perform procedures on children without permission.
It seems in the best interest of the child to complete what's been started.
- Who's the follow-through? - I am.
I'm off work till tomorrow, so I'll stay.
Your actions are totally irresponsible.
You've broken every rule and regulation we have in the ER.
What happens here won't change that.
I want him to have a shot at life.
I don't care about rules.
I hope you also don't care about being an ER Pediatric Attending.
You've given up any chance of that.
- Mark, 7:00.
- What? Seven o'clock.
Rise and shine.
Did you hear from the PICU about that baby? Haleh just went off duty.
She didn't mention anything.
Am I supposed to wake up Dr.
Weaver? - She stayed too? - Snoozing in Exam 4.
Let her sleep.
Come on, girls.
Sweep, sweep, sweep! - Randi's in my way! - I'm supposed to be here! - Curling? - We were inspired by Nagano.
Three years and nine months left till Salt Lake City.
These crazy white folk.
You having a slumber party? No.
Did you hear anything from Doug? No.
Is that why you spent the night? I was nostalgic for my residency.
I thought Carol was here.
She is.
But she's on a break.
There's no new patients, why'd you wake me? - Haleh said 7:00.
- That was for Dr.
Weaver.
Forget it.
I'll just get some breakfast.
Can you call Anspaugh and find out his schedule? - I need a meeting with him soon.
- Okay.
- You didn't answer me.
- No idea how they got their names.
The drinks go down so smoothly at the Velvet Lounge.
- I wouldn't know that.
- That's what this is about.
I was drinking and you weren't.
- You know I don't drink.
- You think I drink too much.
Damn it, we missed the 7: 10.
We can get the next one and cross over at Madison.
No, I can't.
I've gotta go to Carla's and pick up Reece for daycare.
You always like this after a night out? What? We saw the whole show.
We didn't need to stay for another set.
- I thought we were having a good time.
- We were.
Until I made that song request.
The look on your face There's some places that you go to listen to the music, just listen.
So it's not like the pub where you can play darts nobody cares if you drink too much or put something stupid on the jukebox.
I'm saying in a place like that, it wasn't cool.
Well, if you ask me, being cool seems somewhat limiting.
You taking this one? Yes, I think I will.
I'll see you in there? - Yeah.
- Okay.
Why didn't you wake me? I have a meeting with Anspaugh.
We woke up Dr.
Greene by mistake.
We just got two bounce-back migraines.
One's mine.
A fractured clavicle, complaining of coldness to his hand.
A suicidal guy with intention marks to his left wrist.
Who else is on? Del Amico, Jeanie and Carter are coming.
In other words, they're late.
I'm the only one here.
Why is that? Thank you, Lydia.
I'll be right out.
- I thought you might want a refill.
- I just got one.
Thanks.
- I hear it's supposed to rain.
- You want to talk about last night? - It's very serious what Doug did.
- You mean what we did, don't you? It's the nature of your job to assist a doctor when they ask you.
I was there because I wanted to be.
Not because Doug asked me.
I'm sure you were.
Doug can be pretty passionate about these kids.
Oh, give me a little credit, Mark.
You think I'm a fresh-faced nursing student under the doctor's spell? I'm only saying that Legal and Administration are going over every detail of this case.
I'd hate to see it reflect on your record.
So you're saying I should fudge my involvement? Tell the truth.
Tell them you were assisting a doctor.
I insisted on being there because Doug was working in the best interest of the patient.
And that's my job.
Every bit as much as it is his.
I gotta get back.
We had our noses pressed on the glass.
The tracks moved right beneath us.
- You've never done that before? - No.
All you have to do is ask.
- Hi.
- John.
Have you ever ridden in the front car of the El? With the driver? - I don't think so.
- Anna and Dr.
Rosher just did.
Max.
Please.
Max.
Max.
See you.
- That sounds exciting.
- Yeah.
Max just asked the guy if we could.
- Pretty clever.
- Well, thank you, John.
You'll give me that one.
But maybe not the next.
I gotta go pry a kid's leg out of a shopping cart.
Call Maintenance.
Bolt cutters'll do it.
Right.
Does feel cold.
That's what I'm saying.
It's the damnedest feeling.
Nails are cyanotic, cap refill's poor and he barely has a radial pulse.
Doesn't sound good.
I want to get an ultrasound and an angiogram to rule out a blood clot which affects blood flow to your hand.
Whatever you need to do.
I've got great insurance.
You get excellent care here even without it.
- Can I talk to you? - Of course.
Can you get consent from Mr.
Wass and schedule him? Okay.
I have a call into Anspaugh's office to talk about Doug.
- I'm seeing him in a few minutes.
- We need to be involved.
My meeting's about something that's been on his calendar for a while.
- I'll set up another for us two.
- Let me know the time.
Don't worry, I will.
Send home the rule-out appy in 3 with the diagnosis of constipation.
Is there a good trauma on its way? No.
But this letter came down for you from Dr.
Romano.
He's a weird little dude, isn't he? - Did he drop this off himself? - No.
It was his secretary, I think.
Where is he now, do you know? It's not my job to keep track of stuff like that.
On our way in he drank all of his juice without spilling.
Go play.
There you go.
Is he pretty responsive to you these days? As responsive as a one-year-old can be.
Why? Sometimes it's hard to get his attention.
Have you had his hearing checked? - What? - It's not a problem.
Just things we notice.
Reece.
Reece.
Come here, man.
Come here.
Come here.
Oh.
I know.
I know.
He seems pretty responsive to me.
He probably gets distracted by all the other kids.
Listen, Carla's gonna pick him up around 4, okay? Sure.
That's fine, Dr.
Benton.
Who's hiding? Who's hiding? Hi, Reece.
Who are you playing with today, huh? I just feel so ridiculous.
I never really meant to kill myself.
So it wasn't just an accident? You see, my wife and I, we had a fight, you know? And So I went out to my workshop I brought a glass of orange juice with me and I dropped the glass and when it broke, there was a shard lying there and I just I was just so angry.
- So it was impulsive.
- It was stupid, is what it was.
I worried my wife.
Although it's nice to know she cares.
- This is Jeanie Boulet.
- I'm a Physician's Assistant.
I'll suture up your cuts.
Shouldn't be more than a few stitches.
A Psychiatric Resident will speak to you.
Oh, listen, I'm fine.
Okay? This was just a mistake.
I really don't need that.
We're sure it was.
But it's required in a case like this.
Oh, man.
Give it more time.
Kerry.
Hi.
We're finishing up.
Doug called an emergency meeting to fill us in on Josh McNeal.
I'm familiar with it.
Because of the circumstances, I wanted to bring everyone up to speed.
Doug has admitted to stepping over the line.
But he prevented the baby from going home.
Anesthesia and Pediatrics needed to be involved.
And he needed to get the mother's consent.
He wouldn't have gotten it if it meant losing her methadone.
I knew Max was doing a feasibility study on ER Pediatrics.
I didn't want to jeopardize that.
I think it's still the best thing for County General.
Doug, I don't want to minimize the ramifications of this.
- But thank you for coming forward.
- Sure.
If you'll excuse me, I want to get to PICU.
Doug, thanks.
We'll talk.
Don, I don't think I need to tell you that Doug's actions violated every policy we have regarding patient care.
I know.
And there'll be a full review and QA.
It may not go so well for him.
But I must say he's certainly there for his patients.
I'm sorry this has eaten into our time.
What is it that you wanted to talk to me about? Well, as you know, when David Morgenstern had his Ml last fall I took over as Acting Chief of Emergency Medicine.
And you've done a fine job with the exception of that little Ellis West/Synergix fiasco.
With Dr.
Morgenstern having resigned, it seems appropriate for me to be Chief of ER.
The department is running well, and we owe you many thanks for your efforts.
Well, I think everyone's responded to my authority.
So it's just a simple change in title.
I'm glad you'd like to be considered for the position.
We will be doing a national search for the best candidate.
But I'm happy you're throwing your hat in the ring.
- A national search? - County policy, as I'm sure you know.
Excuse me.
Don Anspaugh.
How's he doing? Pretty stable.
Turned off the propofol a half-hour ago.
When's Doug gonna extubate? I figured I'd give him a couple more minutes.
Hey.
I was in the middle of a pretty decent dream.
- Was I there? - Big-time.
Did I do the right thing? Yeah.
You did.
Even if we both get fired for it? That would just be icing on the cake.
Kit, you ready to extubate him? He's breathing spontaneously.
Vitals? Afebrile, BP's stable 90/70.
Suction cath.
Okay, buddy.
Prove us right.
Get ready to bag him.
I'll do it.
Here we go.
Pulse ox? Holding steady.
98 percent.
Do you think he's gonna make it? Too soon to tell.
- Shirley, I'm looking for Dr.
Romano.
- He's not here.
- Do you have his schedule? - He's not here.
He went to some head-and-neck conference in Costa Rica.
- He doesn't do head-and-neck.
- Maybe he wants to learn.
Maybe he's just playing golf.
- So when's he due back? - Teresa does the travel scheduling.
Lovely.
Where can I find her? Right here.
Except she's on a break.
I wanted to inform you on a patient.
He's a 7-month-old boy, addicted to heroin.
- His mom stole his methadone.
- You know? Doug briefed us with your Chief and some of the Pedes.
There was a meeting? Kerry, I'm sure, can give you the highlights.
Anspaugh seemed calm.
But, man, if that had happened at CHoP Doug would've been fired.
Anyway, I gotta go to chart hell.
- You seen Kerry? - No.
Sorry.
We're concerned you get angry in a self-destructive way.
Look, I know I should handle it better.
Okay? And I will.
But I really don't want to stay overnight.
I'm not a crazy person.
This was just stupid.
I need to talk to you for a minute, Dr.
Meyers.
Excuse us a moment.
- He isn't staying? - I don't have a reason to keep him.
I pulled up his old records.
He's been here 3 times in the past year.
Migraines, abdominal pain, back pain.
- Think he's drug-seeking? - He wants help.
Depression is not grounds for admission.
- Hell, that'd be half the city.
- He's released? He's responsive, doesn't seem suicidal or psychotic and he's willing to come in for a follow-up.
I wish we could do more.
He's fighting with his wife, job isn't good- I know; half the city.
- Have you seen Dr.
Weaver? - Usually she's everywhere.
Do you think it's too late to reconsider my ER residency? Oh, you getting bored? Oh, I just cleaned out an old guy's ears.
And dislodging a 5-year-old from a shopping cart- - Any unsickly patient is good.
- Stop complaining.
- By 9:00, I'd been puked on twice.
- I also did two bowel disimpactions.
Do you want to answer the phones instead? Why don't you take the coma patient in 4.
- Paramedics have a double trauma.
- Double? Two Elvis impersonators crashed into Lake Michigan.
Cool.
- Ooh.
Maybe, Dr.
Greene, I could - No, take the coma patient.
Jeanie, Anna how about getting a handle on the "Elvi.
" We got your Over-the-Hill Elvis.
Here's Junior Elvis.
Parachuted out of a plane to land on a pier.
Lines got tangled.
Lake landing.
But he's up there picking his pimples.
- Can't skydive to save his life.
- At least I can do Elvis.
That's more than I can say for you.
I was doing Elvis before you was even born.
- I'll be doing him after you're dead.
- Shall we? You need anticoagulation therapy in order to prevent any further clotting.
- In the hospital? - Not necessarily.
There's a fairly new drug, enoxaparin which you inject under the skin in your abdomen twice a day.
My wife could do that.
You're an excellent candidate for it.
Or you'd have to stay here for a few days- I don't want to do that.
I'll take the drug.
Okay, good.
Kerry, I need to talk to you now.
Sure.
Nurse Jarvik will discharge you.
- Thanks.
- You're welcome.
What do you got? Two jokers fell in the lake out of an airplane or something.
That Doug Ross meeting happened this morning.
- It sure did.
- I asked specifically to be notified.
Mark, nobody told me either.
I just walked in on it.
You could've mentioned it so I didn't have to hear about it third-hand.
- I had patients.
Give the bullet.
- I already did.
Give it again.
- A Junior Elvis- - Jeanie, we've got this.
Help Anna.
Tell that wanna-be his "Heartbreak Hotel" sucks the big one.
Oriented and alert.
Vitals normal.
BP 120/70.
Cap refill's fine.
BP's high.
180/120.
- Good luck.
- Better here than in there.
Those two make the Elvises sound like Boy Scouts.
- Spin a crit and dip a urine.
- Want a Chem-7? Sure.
- Why didn't they tell us? - Why don't you ask your pal Doug? - Do you think there'll be an inquiry? - Hopefully, Doug will let us know.
Why're you angry at me? I didn't detox a baby and hide it.
But giving him an inch, he gets away with a mile.
- So this is my fault? - It's not a question of fault.
It's about style.
You close your eyes and hope things will disappear.
Here.
When I try to come down firmly, you tell me to pull back you fight me and it'll disappear.
It's not disappearing this time, is it? It's not the time or place to discuss this.
Chuny, let's repeat a BP, please.
- Mrs.
Lang, this is Dr.
Carter.
- How do you do, Mrs.
Lang? I've just been going over your chart.
- I see your husband has- - I couldn't wake Bill up this morning.
He was diagnosed 14 months ago with brainstem glioblastoma.
They tried to do radiation therapy.
But that didn't work.
He's had some visual disturbances and some paralysis.
But we were not expecting this.
We'll do everything that we can.
Let's order an MRl with gadolinium.
Get in a Neurosurgery consult and the Oncology Fellow on call.
I hope it's okay that we opened the window.
Bill, he just loves the smell of the rain.
That's fine, Mrs.
Lang.
Last time I complain about kids in shopping carts.
- What? - Never mind.
- Oh, hi, Adele.
- Hey, Carol.
This is Vicki McNeal.
This is Josh McNeal's mother.
Baby Josh, right.
- Hi.
- She'd like to see her son.
- Thanks.
- Dr.
Benton.
- Randi, an audiologist is gonna call.
- An "audi"- what? Hearing tests.
Write it down.
But we've got an MVA coming in.
A Mazda versus a milk truck.
I'm just signing charts.
But I can't find Dr.
Corday.
Upstairs says she's checking out Costa Rica.
- What? - That's what I said.
About the MVA? Oh, damn it.
- Dumar, what do we have? - Sam Wiser, 32.
Head-on TC.
Head, neck and abdominal trauma.
- Did she ask about consent? - I don't know what Adele told her.
Ms.
McNeal.
Is he gonna be all right? Well, he's stable.
His blood pressure's holding steady.
He's sleepy.
But it's expected after a prolonged sedation and intubation.
Intubation? A tube down his throat to help him breathe.
He was asleep while they did it.
I explained to Vicki about the ultrarapid detox.
How the drugs'll be out of his system.
So he'll be able to sit up like other kids.
We believe he'll be able to catch up.
The procedure went well.
We just have to wait and see.
So what I wanted to know then, Dr.
Ross, is could you do the same thing for me? I'm gonna kill you! Why? You offered.
You get my patty melt? Yes, I got your patty melt.
Hey, will you help this gentleman? He's looking for Dr.
Weaver.
Sir? - Can I help you? - Yes.
I'm looking for Dr.
Weaver.
Dr.
Weaver? - Mr.
Wass, what are you doing back? - I couldn't get the enoxaparin.
It's $500.
My insurance won't cover it.
They'll only cover something called heparin or Coumadin.
- Coumadin.
- I should be on that? You need to be hospitalized for those.
I'll call the insurance company.
Can you get Mr.
Wass' insurance information and put a call in, please? Carol, you know, I had a meeting with Dr.
Anspaugh this morning.
There will be an executive committee review of the Josh McNeal case.
Doug told me.
It'd be in your best interest to document your participation while it's still fresh.
Oh, that experience isn't going away anytime soon.
You should hope neither you nor Doug Ross is either.
Dr.
Weaver? Mr.
Wass' insurance? Thank you.
Yeah, Dr.
Weaver.
No.
No, no, no.
I don't want the claims department.
I need a medical supervisor.
Mrs.
Lang? MRl is backed up.
It'll be a little while longer.
I've got Nurse Hathaway checking.
He is gonna wake up, isn't he? His doctors thought we had longer.
We really won't know anything until we get those test results back.
Is there a phone here? I want to call my daughter.
She's a freshman in college.
Tulane Drama School.
She didn't want to go because of her dad.
But Bill, he insisted.
He said that it was enough that his life was being put on hold.
I don't know.
Maybe we made a mistake.
Looks like an avocado.
Dr.
Corday.
Sorry I'm late.
You were on trauma call when Mr.
Wiser was brought in.
Dr.
Benton was kind enough to cover while I was away.
You've reviewed the chart? - Avulsed gallbladder.
- Can I get some suction here, please? Let's say you find a significant pancreatic injury.
Crushed duodenum and common bile duct.
What are you going to do? A Whipple, which as you know I performed solo back in England prior to my fellowship.
Yes.
I think I did know that.
Speaking of fellowships, can I ask you about the possibility of sponsorship for next year.
What about Dr.
Romano? It seems Dr.
Romano doesn't wish to continue with me.
What? He served me notice today.
And he's unavailable at some head- and-neck conference in Costa Rica.
It's too late to arrange another fellowship at County General.
We're past application deadlines.
I was hoping for individual consideration since I've spent a year here.
The committee always seems to frown on that.
- You really want to stay in the US? - Very much so, yes.
If it's staying in America, you could marry an American.
- Shirley.
- Sorry, Dr.
Anspaugh.
Your guidelines are wrong.
He needs anticoagulation therapy.
And he doesn't need to be admitted.
- Dr.
Weaver.
- What is it? The renal failure guy's here.
Okay.
I'll be there when I can.
You know, I would like to get your name.
Rufhauer? Rufhauer.
Louis Palmieri, 84.
End-stage renal failure.
Full cardiopulmonary arrest.
His femoral dialysis catheter had been disconnected.
- Sheets were drenched with blood.
- Will he be okay? Would you stand back please? No pulse or heart sounds.
Intubated.
Two amps epi, two of atropine.
Reattached saline to the catheter, two liters.
That does it.
- No pulse? - No.
Amp of bicarb and a high-dose epi, five milligrams.
- Please be okay, Louis, huh? - No heart sounds.
He's PEA.
Spin a crit and four units O-neg.
- Try a transthoracic pacemaker? - Yes.
- What? - Getting his heart going.
- Turn up the gain.
- You a relative? - Not exactly.
- It's not capturing.
- You did come with him.
- Yeah.
I drop by his house every week.
Mrs.
Lang? Your husband's MRl results are done.
The tumor is blocking his It's a blockage that's increasing intracranial pressure.
- And that's causing the coma? - Yes.
So can it be unblocked? Yes.
A neurosurgeon can perform a ventriculostomy.
So Bill could come out of this? He could.
The outcome is problematic.
Your husband would have very little time.
And it may cause him a great deal of pain.
He would most likely die of respiratory failure.
But Bill would wake up? I mean, I could talk to him again and he could hear me? Yes.
Or he could stay the way he is now and die peacefully.
- She wants to handle the funeral? - He has no family.
- What's her relationship? - Friend.
- She looks like a hooker.
- She is.
She's been "attending" him twice a week.
- Did you say he had a Foley catheter? - Yes.
- Excuse me, Miss? - Myra.
Miss Myra.
I wonder if you could tell me exactly what happened.
I've been seeing Mr.
Palmieri twice a week for the past couple of years.
It wasn't a lot of money.
But then I was only providing manual relief.
But today my bracelet here got caught on that little tube.
When I pulled back, it popped out.
The next thing I know is, there's blood everywhere.
- So I called 911 right away.
- I see.
Dr.
Weaver, some insurance company's on the phone.
I'll be right there.
Excuse me.
I say give her the body.
You were here a little while ago talking to Dr.
Greene.
Yeah.
Have you seen a vial of Percocet? I lost it around the drug lock-up.
No, I haven't.
But I'll keep my eyes open.
- there's always a pile of these.
Now I gotta pore over these.
Went through the last two weeks.
You guys do a lot of kids.
- Elizabeth.
- I haven't much time right now.
- I'm trying to catch Langstaff.
- Langstaff? I've heard she isn't too keen on her Fellow.
Thinking of letting him go.
I want to get a word in.
Well, shouldn't you wait to see if she does let him go? I want to let her know I'm available.
And desperate.
Excuse me? I mean, asking Dr.
Anspaugh in the middle of an operation? - He didn't seem put off.
Why're you? - I'm not put off.
If it's about me hanging you up, I'm sorry.
I appreciate you covering.
I wasn't hung up.
Yeah I would've appreciated a page letting me know about Romano's letter.
Look, I would have discussed it with you.
Romano was my first priority.
That bastard didn't even give me a reason.
He's not required to.
He sponsored you.
I mean, it's his call.
You're taking this in stride.
It's not necessarily about you.
It's very much about me.
You don't know how hard I worked to get here.
- I do know what it takes.
- Then why aren't you being supportive? You're doing it the wrong way.
You're running all over, asking every surgeon to sponsor you.
So, what do you suggest? You haven't checked out other hospitals, other parts of the country.
I've built up relationships here.
Or so I thought.
I'm not saying I want you to leave Chicago.
No.
But you're not passionate about my fight to stay.
- Whatever goes on between us- - Peter.
You ready to scrub on that small bowel infarction? Yes, sir.
Please let me finish.
You understand that admitting the patient- - I need you to sign.
- I'm not working.
- These are from yesterday.
- I'm not working.
Josh McNeal is doing much better.
You didn't tell me about the meeting- No! I mean, your policy is not sound, Dr.
Stork.
It's obscene.
I mean, you're spending 10,000 to save 500! Then so be it! I will admit Mr.
Wass to this hospital! And I look forward to billing you for every damn dime we can possibly spend! - Admit Mr.
Wass.
- Want me to call them? - That'll help.
- I don't know what helps anymore.
- I don't care.
Because I quit.
- What? I quit as Acting Chief of Emergency.
Let somebody else "act.
" Wait.
Why am I the only idiot who's worrying about policy? Doug's got the right idea.
Break the rules if it helps the patient.
Everything else be damned! Where do I get by trying to follow them? - Look, Kerry, wait.
- No! - If anybody needs me, I'm outside.
- Cool.
Hey.
- Hey, Carter.
- Getting some air? - Yeah.
I need it after my last case.
- Yeah.
Me too.
I was just talking to Lydia Wright.
And she mentioned to me that some Percocet's been missing from the drug lock-up.
- That's low, Carter.
- Hey, I'm not accusing anybody.
You're my friend.
I want you to know.
Well, Max is clean.
- Well, maybe he is.
But- - But what? That's what Chase used to say to me.
I gotta get back.
Vitals are stable.
The boy's alert.
You got your next journal article.
Right after they draw and quarter me in front of the committee.
Thank you.
We don't always get results this good up here.
I'm going to go check on the Yezerski kid.
What will happen? Back to his mother? Who knows? I gave her a list of names of doctors who do ultrarapid detox on adults.
But it doesn't change the psychological addiction.
At least she's trying.
Come on, buddy.
- I was just coming to look for you.
- You knocking off already? Going to St.
Mark's to see how their unit's doing.
When you off? - Seven.
- Want to get dinner at Johnny D's? Yeah, sure.
Feeling good about getting through those charts? Yeah, it'll be a week or two before I can get a report out.
If you can stand to have me around that long.
What's your recommendation? What happens when I recommend in favor of an ER Pedes Department is they ask me to run it.
I've always said no.
But this time I could be convinced to say yes.
- You mean stay in Chicago? - Only if you want me to.
Wow.
I hadn't really thought that far ahead.
Heard some Percocet was missing.
Yeah.
I heard that too.
I didn't take it.
I didn't suspect that you did.
You'd be crazy not to.
I didn't want to suspect that you did, anyway.
Don't feel bad about it.
I know I've used up all my free passes with you.
But I'm telling you the truth.
And I'm willing to prove it.
Every day.
It's not that I don't believe you.
- It's just- - Anna? - Labs are back on that Ml.
- Thanks.
I'll be right there.
All right, go.
Be a doctor.
I'll call you later.
Sure.
Where's Mr.
and Mrs.
Lang? Mark signed a transfer to White Memorial.
- Why White Memorial? - Maybe his doctor's there.
- Will they do the ventriculostomy? - She didn't say.
Did you tell her there wasn't much they could do? Just would've liked to know what she chose.
- Why? - Why? I don't know.
Just seems unsettled.
Unfinished.
We never know about people when they leave.
You haven't seen Anna around, have you? No.
- There it goes again.
- What? That car alarm.
It keeps starting up and shutting off, and starting up.
- Annoying.
- It's in the ambulance bay.
I called Security.
But who knows where they ever are? Mark, Kerry, this is the action report on Josh McNeal.
Like maybe why you lied to me? - You didn't understand.
- You didn't give me a chance.
Take it outside.
We got work to do.
If you're no longer Acting Chief, who do I give these budget reviews to? I'll take them.
This kid was more important.
You always have a patient excuse.
I'm willing to go out on a limb.
You took the whole tree with you.
I was trying to support you.
To be the Pedes Attending? You weren't going to support me.
We'll never know now, because you did what you always do.
When you're about to get what you want, you sabotage it.
- Is that what you're so angry about? - I'm not angry.
I'm disappointed.
You like that.
It validates that you're the adult and I'm the screw-up.
You never wanted to grow up.
You like it this way.
We hang out, but you're the boss.
For good reason, based on your actions.
Based on your inability to see me as an equal, Mark.
- Bad enough Kerry stepped up.
- I support her.
On the surface.
Underneath, you resented her.
Like you resent what I did with Josh.
Where's Mark? He needs to sign this.
He and Dr.
Ross are outside "sharing.
" Mr.
Nable? What are you doing here? Mr.
Nable, are you hurt? Are you okay? Come on.
Come with me.
Come on.
I'm so sorry.
Where's all this blood from, Mr.
Nable? Come this way.
I'm gonna check you over.
You just sit down right here.
That's my car.
The alarm's always doing that.
I don't know why.
You drove here? We'll get someone to turn that alarm off for you.
Do you have a remote button? Oh, God.
- There weren't enough bullets.
- All right.
Jeanie, stay with Mr.
Nable.
Just be careful.
- Stick this somewhere.
- Cripes.
And call Security to help Jeanie.
Doug, Mark, come on! The car! Come on! - What is it? - Locked.
- Who's in here? - Can you see anyone? - I can't see.
- Something's in the back seat.
- It's two kids! - I'll break a window! Woman in the front, two kids in the back! Hit the latch! The door won't open! Got it! Jerry! Get us three gurneys, backboards, and head collars! Get some help too! I got a 40-year-old woman.
Gunshot wound to the left neck.
Weak carotid pulse! She's barely breathing! Looks like a GSW to the abdomen.
- What's going on? - Ambulance bay.
- Get those out there.
- I got the flashlight.
- Everyone use blood precaution! - What is it? Get outside and help.
Lydia, call for O-neg.
- How much? -15 units.
- Close us to Trauma, page Surgery.
- Kerry.
- Wait.
- No.
This is the guy.
- What guy? - What happened outside.
Mr.
Nable Okay.
Call Security now.
Move him to Curtain 3.
Post someone at the door.
Yosh? Help Jeanie with this man.
- Jerry, push the gurney closer! - C-collar's secure! - Anything else I can do? - Yes! Help lift her! Watch her head! - Gently! Gently! - All right, we got her! - Get her legs.
I'll support her neck.
- I'm underneath her.
- Supports are in! - Mommy! Where's my mommy?! - It's okay, honey! - Slide her out really slow! Get this side! - Got it! - Weak carotid pulse.
Flat neck veins.
Decent respiratory effort.
Trachea midline.
- I got the backboard! - We'll roll him.
Roll him.
- Nice and easy.
- Slide it.
Let's move him back.
Malik! Give me a hand! Top of the board! On my count.
One! - Go! - Two! Three.
Three.
- Start a line.
- Which one? Little girl.
Good breath sounds on the left.
A few crackles at the right base.
I'm Dr.
Weaver.
We'll take good care of you.
What's your name, sweetie? Amy.
CBC, Chem-20, two lines saline wide open.
Cross for eight.
Not moving much air.
I gotta tube him.
6.
5! - Pulse 120.
- BP's 70/50.
- Suction.
- Got it! - Need O-negative on the rapid infuser.
- I'll get it.
- What's going on? - Guy shot his wife and two kids.
Oh, man! - Damn! - We're going to help you.
Doctors are helping your kids.
We'll tell you as soon as we know anything.
- Elizabeth? - Intubated.
Had a respiratory arrest.
- Where's the wound? - Neck.
BP's 80 palp.
Start dopamine.
Ten mics per kilo per minute.
High-dose Solu-Medrol.
- How much? -50 mgs per kilo over 20 minutes.
Then five per kilo per hour.
Send pre-op labs.
We need X-ray in here for a portable C-spine.
Dr.
Benton, a Jackson Kroopf's on the phone for you.
- Who? - Something about a hearing test.
- I'll call him back.
- Carotid's okay, what about yours? Strong.
It missed the major vessels.
Any sub-q air on your side? No.
Tube went straight in.
Trachea's intact.
What's her name? Husband's name is Nable.
Mrs.
Nable can you squeeze my hand? That was good.
Try again.
- X-ray's here.
Where's Mark? - Next door.
The police are here.
Mr.
Nable needs to be cleared.
In a minute.
Can you find out this boy's name? Be nice to know.
Chest tube, 28 French.
Thora-Seal.
- Two more units on the infuser.
- Getting hard to bag.
- Yeah.
Poor air entry on the left.
- Lost the pulse.
- Asystole.
- Start compressions.
- Not feeling a pulse.
- Bleeding out.
Get a central line kit.
Crack him.
Thoracotomy tray.
Get me a 10 blade.
- We need to know your son's name.
- Is he gonna be all right? They're working on him right now.
I turned the gun There weren't anymore bullets.
- I need a chest tube.
- What are you doing? There's a hemopneumo.
Wound's in the seventh intercostal space.
It may be intra-abdominal.
- May not need chest tube.
- Exam indicates hemopneumo.
She's stable.
Lydia, let's get an x-ray.
I don't think she's too stable.
- Does it hurt anywhere else? - Take my hand, sweetheart.
- Are my mom and my brother okay? - They're taking care of them.
I thought we'd drive here and everything would be okay.
- I know.
- Why did my daddy have a gun? My mom said we'd go with him if he came here to talk to somebody.
It's okay.
I thought we'd just talk to somebody.
- Prime the lines.
- Satinsky.
Suction.
I'll do it.
What do you have? A hole in the heart.
Right ventricle.
Keep your finger on it.
Line's in.
Hook it up.
- Rapid infuser ready.
- I'll occlude, you sew.
Hold compression.
Put your finger on the defect.
Don't stick me.
Chuny, we need more blood.
Okay.
Hold this.
- How is she? - She'll make it.
But her spinal cord is injured.
Taking her to CT now.
- All right, let's move.
- Keep me apprised.
- Did you call the O.
R.
? - Waiting for us.
You're gonna be okay, Amy.
We're going to surgery.
We'll let you know how your family is.
Tell the surgeon to call us when he knows anything.
- How's the boy? - Still working on him.
- Let's call that Psych Resident.
- I did.
- He's coming back in.
- Great.
She was gonna take Amy and Steven with her.
I couldn't let her do that.
He's in V-fib.
Internal paddles.
- What do you need? - Charge to 15.
- Heart's failing.
- Epi's onboard.
- Charging.
- Clear.
Still V-fib.
Again.
- Clear.
- Clear.
- Still in fib.
- Charge to 30.
Carol, intracardiac calcium.
- Clear! - Clear.
He's got a rhythm.
Suture's still holding.
Strong carotid pulse.
His name's Steven.
Call the blood bank.
Have them send up eight units to the O.
R.
- I got it.
- Grab those lines.
Help me bag him.
Stat page the Thoracic surgeon.
Chuny, call the O.
R.
Tell them that we're on our way.
Carol, lidocaine, 1.
5 mgs per kilogram bolus.
- Put him on two mg per kilogram drip.
- Got it.
Malik, get me a gram of Ancef.
And call for platelets and FFP.
- BP's 80 palp.
- Tell Security to hold the elevator.
Secure subclavian and attach CO-2 monitor.
Bag him at 24 a minute.
He's probably acidotic.
Everybody ready? All right, let's get him up.