ER s06e12 Episode Script
Abby Road
E.
R Previously on E.
R.
I'm Abby.
I'll be your OB nurse.
I just can't lie about a diagnosis.
Sometimes we make what's call a judgment call.
If the rules need to bent a little, then we bend them.
You wanna go grab some dinner? Peter, you asked me out? It's never been very easy for me to be here.
That's something I know about.
E.
R.
6x12 "ABBY ROAD" One minute I'm freezing, the next I'm burning up.
I can't keep things down.
Sir, it's the flu.
It's going around.
I got body aches, nasty cough.
I really need to see a doctor.
- Sit, we'll get to you in a minute.
- You said that an hour ago.
- I need to go home.
- Forget it.
We're shorthanded.
- I puked.
I gotta go.
- So did half the Radiology techs.
- I've got a fever.
Feel my head.
- Feel your own.
- Cold and flu season has hit hard.
- Yes, take your pick.
Fever, sore throats, runny noses aches and vomiting.
Why don't they go home? - It's coming out both ends.
- Thanks, Dave.
The lab is full.
It takes four hours to get a CBC.
They're 40 behind.
- You look bad.
- I look better than I feel.
No beds, we're boarding 7 patients.
Carol called in 2 registry nurses.
God only knows when they'll get here.
You should see a doctor.
Me too, or I'll expose the patients.
Take some Imodium.
Wear a mask.
- You touch the thermostat? - I just cleaned it.
- Hello, Mark.
- Good morning.
- Did you run the faucets? - Yes, it was freezing.
I had to boil water to wash my hair.
- I need a plumber.
- Let me look at it again.
A plumber will try to sell you a new one.
It's old, not dead.
What? - Kovac is fixing your water heater? - Trying to fix it.
He was dropping me off.
From work.
I was complaining it was making some noise- - Why am I explaining? - Beats me.
- Don't think that.
- Think what? - It's not that.
- It's not what? It's not anything.
- Move back, now.
- Coming through.
- If you've got the flu - Hi.
is too late for a flu shot.
- I'm Abby, they're expecting me.
- ER, please hold.
Please hold.
Abby.
- Did they send you here? - Yeah.
I was wondering when we were gonna get some help.
- Carol.
- Hathaway! - You were my OB nurse.
- Twins.
How are they? They sleep well, just not at the same time.
How do you do it? Not easy, but neither is managing 36 patients.
- Actually- - Coming by! I found this guy.
He can't walk.
- What's open, Carol? - If you can find a bed, grab it.
- Sorry.
- Call Housekeeping! Med students think we're their maids.
We're swamped.
- Actually- - Chest film for Mr.
Sranski.
- Sranski? - Flu patient.
- You need scrubs.
- No.
I don't think- - Haleh, do we have scrubs? - I don't care.
We do get along.
- You believe in zombies? - What? Human cadavers walking the earth after they've died? - No.
- There's a body still in Exam 1.
- I called Transport.
- Piggyback it out.
I need the bed.
- Residents, worse than students.
- Right.
Can somebody take this? - Did you call ahead? - Yes.
Todd Sullivan.
Good vitals.
He crashed while sledding.
- I lost my teeth.
- Don't worry, they're your baby teeth.
- Malik, can you call a doc? - Right.
Good luck.
He needs a C-spine and a head CT.
- We need a doc to order it.
- I can do it.
- What? - Students work on patients, right? - I'm a 3rd-year.
This is my rotation.
- A med student? Yes.
What can I say? I crossed over to the dark side.
Films are clear.
I paged an oral surgeon.
- Update his tetanus? - He had it last year.
- I guess not.
I'm Luka Kovac.
- Abby Lockheart.
I'm a third-year.
Another new Resident? - I'm a med student.
- Another half gram of Ancef? - Abby? - Sure.
Sounds good.
Okay.
Nice job.
We never had doctors like that in OB.
- Easy on the eyes? - I'll say! Is he single? He doesn't talk about it.
Tall, dark, handsome and mysterious? - What are you doing? - Cleaning.
- I got it.
- Don't be silly.
Really, I got it.
Okay.
Carol.
- Can I see pictures of your girls? - Sure.
He has to take his pills every day.
- He forgets.
- Maybe you can remind him.
I forget.
Put a note on your medicine cabinet to remind you.
That's a good idea.
I'll try to remember that.
I'm feeling horrible.
Can you cover my shift? - Must be bad if you're sick.
- I'd rather die at home.
Make sure the new student doesn't kill anyone.
- Leave her alone.
Abby- - Give me a break.
Suck it up.
Abby, meet Mark Greene, Attending.
- We've met.
- Yes.
See you tomorrow, if I live.
- She wasn't wrong? - I'm a med student.
- And an OB nurse.
- I do it to pay the bills.
Right.
Welcome to the glorious ER.
- Has anyone given you the tour? - No.
Start by signing up for your patient.
Grab a T-sheet based on complaint.
Nurses' orders go here.
- Labs and x-rays go here.
Questions? - So far, so good.
That's Curtain Area 1.
This is Area 2.
Yosh Takata.
- Wave hi to Yosh.
- Hi.
- Trauma 1, Trauma 2.
Haleh- - We've met.
- Hi.
Still hurting, Todd? - A little.
We gave him 4 morphine.
Can we give him 2 more? - Yes.
You need this tour? - It helps.
Come on.
The tram doesn't stop.
Keep your hands and arms inside.
What's this? Darnel Smith has muscular dystrophy.
Possible forearm fracture.
- What happened? - I was pushed down the stairs.
- In your wheelchair? - Duh! - It was a fight.
Cleo has the pusher.
- Let's keep the two of them apart.
- That's Carter.
- Yes.
This is the Pedes ER.
It's a large exam room with pediatric equipment and murals.
- Hey, Cleo.
- Hey.
He freaked out on me in the hallway when I tried to get past him.
You can't push him down the steps in a wheelchair.
I didn't push the psycho until he stabbed me with his pencil.
- What are you looking at? - Don't be rude.
Good news.
His arm's not broken.
I can't believe one of his classmates would do this.
I heard that he provoked it.
- Darnel, is that true? - No.
- He's been acting up lately.
- Is he in special education? No, he's not.
We wanted his life to be as normal as possible.
Got cancer? They'll cut off your penis.
- That's enough.
- Darnel! He's kidding.
- Mrs.
Henry, please wait in Chairs.
- Leave him here? I still need to check him.
All right.
You behave yourself.
I'll be right out in the waiting room if you need anything.
Darnel, sounds like you're having a little trouble in school.
Is this because of your muscular dystrophy? So, suddenly you don't speak.
I can't feel my toes.
You have frostbite.
Do we need to débride? - Is he a diabetic? - No.
He has a respiratory infection.
The frostbite is superficial.
Start him on a rapid rewarm - of 105 degree circulating water.
- Thanks.
Is anybody not sick? It's like the damn plague here.
Are you here to help? It's natural selection.
An epidemic thins the herd.
Where's Kerry? - She went home sick.
- That's why they're the weaker sex.
You booked an O.
R.
for 3:00? Yes.
I'm assisting Dr.
Ashcoff on a facial-scar revision.
- Can't that be done in the Plastics? - He wants general.
How do you fit in? The girl's my patient.
I'm following up on a dog bite.
Yeah, so? Medicaid won't cover it.
I got Ashcoff to donate his time.
I was- We provide medical services to the poor.
Well, that does not include cosmetic surgery.
What's next, liposuction for fat kids? - A little girl is disfigured.
- Peter, I admire your noble effort.
But this kind of thing could lose our state funding.
I'm sorry, big guy.
Will I get lead poisoning from the pencil? - Pencils are graphite.
- Temp's 99.
2.
- Did that hurt? - No.
It's just cold.
Sorry.
- How did you get these bruises? - I don't know.
Who hit you, Marty? - Some kids at school.
- Are you sure? Yeah, I'm sure.
- Do your parents know about this? - No.
- The teachers or the principal? - They'll kill me.
What's this? - Mosquito bites.
- In February? They must be hungry.
You have quite a few.
Look, is my dad coming? He's on his way.
I'll be back.
Get a CBC, Chem-20, and a tox screen.
They're infected track marks.
- What am I looking for? - Top of page 4.
It was a good morning.
- I spotted it while reading the paper.
- What? For Pete's sake! "University of Chicago, Department of Astrophysics will present a symposium.
Guest speakers include" - Isabelle Corday.
Your mother.
- Yes! - I see the resemblance.
- I look like my father.
You didn't tell me.
I didn't know.
It's so like her.
- You guys having a fight? - No, she's just being Mother.
You should call her.
Of course, come to her, that's part of the game.
- Or don't call her.
- I won't.
I'm not playing.
Get off me! I'll kill you! I'll kill you! - Was he trying to hurt himself? - No, he's freaked out.
- On medication? - Drugs! - Looks like PCP to me.
What happened? - He jumped out a third-story window.
He didn't even feel it.
He'll feel something soon.
Get out! - What are you doing? - He needs to see this.
Listen, we're trying to help.
He's broken both legs, exposed bone.
- Ever seen an open fracture? - No.
He's taching away.
Pulse is strong.
Ten of Haldol, IM.
Get those restraints on.
Get that out of here! - Please back up.
- No, this is too good.
- Now! - CBC, tox screen, UA and a myoglobin! - Haldol now! - Restraints or Haldol? - I got it.
- Tetanus booster and a gram of Ancef! Okay, roll him.
Give it in the thigh interior.
- You okay? - Yeah.
Set me up for P.
M.
splints! - You've had Heptovax? - Yes, but patients don't bite in OB.
It's an occupational hazard down here.
Serologies will be back tomorrow.
Don't sweat it.
You're your own teaching case.
Well, I expected the ER to be different.
Stop squirming and I'll get it in.
- You're being rough.
- Stop whining.
Be glad she's not putting in a Foley.
Once you've been bitten by a raving lunatic, you're ready to see patients.
I don't know.
Grab a chart.
And yell if you get into trouble.
- Carol, keep an eye on her? - Sure.
Oh, and update her tetanus.
Press on my hand like you're stepping on the gas.
That's good.
Let's do the other foot.
You do much driving, Darnel? Okay.
Okay.
Now I want you to squeeze my hand.
If you make me scream, I'll give you a prize.
- Give me a break.
- He speaks! Okay, come on.
I wanna see how the MD's affecting your body.
Duchenne's muscular dystrophy is a genetic disorder characterized by the wasting of skeletal muscles.
First you lose your legs, then your arms, and then you die.
That's how it's affecting my body.
- Hold his head still.
- I'm sorry.
He really hates hospitals.
Don't be afraid.
We wanna make you better.
He's good-natured, considering what he's been through.
What surgery has he had? A Nissen fundoplication for gastroesophageal reflux.
A hemicolectomy, and a few laparotomies.
- When was he vomiting? - Today.
Mucous membranes are moist.
Did you feed him orally, or in his G-tube? I gave him a little by mouth.
But not enough to induce this.
I pray it's the flu.
But it may be a bowel obstruction.
Abby, can you get this foreign body ingestion? - Sure.
Just a sec.
- Luka? Can I steal Abby? We're backed up.
It's okay.
Go ahead.
So, what do you think it is? I'm not sure.
I'm gonna have to take some x-rays.
Carol, can I get a weight and a three-way abdominal series? - You dehydrated? - How'd you guess? Jeremy Barnes.
Abdominal cramping, some diarrhea.
A fever with a history of a triple-A.
- How are you feeling, sir? - Lousy.
- Any vomiting? - No.
I feel real nauseous.
- When was your aneurysm repaired? - A year ago.
- Any complications? - No complications.
- I felt great until this.
- It's just the flu.
- Thank you.
- You're welcome.
Maybe he's telling the truth.
School can get rough.
He has skin-popping abscesses.
- You get a tox screen? - It's negative.
He's clean.
- You can't be sure.
- What are you thinking? I don't know.
But maybe you can bluff it out of him.
- You okay? - Somebody stole my patient.
- Peter, did you steal Lucy's patient? - Check the lost and found.
Dr.
Benton? - Hi.
- Mrs.
Fulton.
I took Tia to surgery.
The nurse said she can't have her operation today? I tried to call you.
Please, have a seat.
- There's no availability in the O.
R.
- Dr.
Ashcoff change his mind? No, no, no.
We just have to reschedule.
Well, we came all the way down here.
We can wait.
- Tia hasn't eaten in eight hours- - We can't do it today.
I'm sorry.
I'm not gonna get them fixed? You've waited long.
A few more days won't hurt.
Hold on a minute, honey.
Can we? It has taken me months to get Tia out of the house.
I can't give her false hope.
If this isn't gonna happen you need to tell us.
It's gonna happen.
I just need a little time.
Thanks.
Mr.
Barnes needs Compazine, run saline through and check his electrolytes.
Can't you get a nurse to do that? - You used to be one.
- I'm not now.
You're here to learn.
This is an opportunity to learn how to check his stool for fecal leukocytes.
Thanks.
- What's his pulse ox? -82.
- And how much oxygen is he on? -10 liters.
The flu is making it difficult to breathe.
It ain't just the flu.
No.
You also have congestive heart failure.
A tube will help you breathe.
No.
Thank you.
- Do you have someone we can call? - No.
All my friends is homeless.
No phones.
- Any family? - No.
Okay.
I really think you need to go on a ventilator.
No.
Thank you.
I always hoped I might die in a warm bed with clean sheets, if it's all the same to you.
X- rays show nonspecific bowel gas pattern.
- So, it's not another adhesion? - Right.
Blood gas is back.
PH is 7.
38.
PCO-2 is 30.
Is it respiratory alkalosis? Partly.
But also an acidosis.
It's complicated.
- Are you a nurse? - No.
I've read every book on chalazia.
- Did they do an upper GI? - Six months ago.
They thought he had a gastric outlet blockage.
You're not gonna do that? - It'll rule out an obstruction.
- No, please.
They put an NG tube up his nose.
He wouldn't stop crying.
I know he's been through a lot.
He has a metabolic disorder.
We have to find out why he's sick.
I will be as gentle as possible.
Okay? Okay.
I'll be back.
- What? - You tell me.
Nothing.
We tested your blood, Marty.
Yeah? So? - Where do you get the dirty needles? - What do you mean? Marty, I know.
You can't tell my dad.
Please.
He won't understand.
You can't use dirty needles.
You're infected and if you share, you could get HIV.
Don't worry.
I stole them from my grandmother.
She's got diabetes.
- Why do you do it? - Kids with crooked teeth get braces.
My mom got laser surgery on her eyes.
Why can't I use hormones? - For what? - To grow taller.
You're injecting human growth hormone? Where do you get it? - It's not illegal.
- Where do you get it, Marty? - Off the Internet.
- Then you don't know what's in it.
Do you know the health risks you've been exposed to? It can't be worse than being beat up.
Even that stupid kid in the wheelchair picks on me.
If you can get me the real stuff, I- Hormone therapy is not for healthy adolescents.
Well, I'm not healthy.
I go to school every day knowing that I'm gonna be beat up or shoved into a locker, or dragged into the girls' shower room.
Do you know how embarrassing it is to be stuffed inside a trash can while the whole cafeteria's laughing at you? Hormones aren't going to help that.
Yeah? Well, being bigger will.
- Hey.
- Hi.
- You okay? - Yeah.
- Have you seen the Cetacaine? - No.
- We always keep it on this counter.
- Sorry.
Carol? Are you uncomfortable with my being here? Why would I be? It's hard for nurses when nurses go to med school.
I switched teams.
I'm gonna be sick.
Actually, I almost went to med school myself.
- Is it something else? - It's just stupid.
Oh, my God! - Have you had an ulcer? - What's wrong with him? I don't know.
I'll get a doctor.
- I need a Yankauer.
- Top drawer.
Peter! I'm gonna start a line.
Check his BP.
He just started vomiting bright red blood.
- What's the history? - Looks like triple-A.
- Ulcer, I think.
- Think? - He's not my patient.
- Okay, here we go.
Set me up for a central line.
Squeeze in two liters.
Get me four units O-neg.
- What's wrong? - Bleeding through his GI.
- Call the O.
R.
- What happened? - Aorto-enteric fistula.
- Should we take him? - Just tube him.
-80 ET.
- Damn it! - Now! - Why is he here? - Corday said it was the flu.
- His pulse is weak.
BP's 50 palp.
- We need to stop the bleeding.
- What's your name? - Abby.
- Can you sew this? - Yes.
A suture? As long as it doesn't pull away.
- Prep him for a lap.
- You can't do one here- No choice.
Scalpel! I'll make a small midline incision, and clamp below the diaphragm.
- Got that? - Almost.
All right.
Let's go.
- Pressure's at 90.
- This should hold him.
Tell the O.
R.
we're coming.
- Two units of O-neg in.
- Operating in the ER, Peter? - He had an aortal-enteric fistula.
- Why isn't he in surgery? - He had flu symptoms.
- Look like the flu, Malatucci? - Malucci.
No.
But Dr.
Benton- - Save it for the disciplinary hearing.
Let's get him to O.
R.
before you use the rest of our blood supply.
You got to admit, that was pretty cool.
- Can I go home now? - Not just yet.
- I want you to try something first.
- What? - Computer.
- I've seen one or two.
Maybe the MD's affecting your motor skills and causing trouble at school.
- Wrong.
- You can keep up with other kids.
The school is full of losers.
Oh, well.
Come on, just give it a try.
Oops! - Feel better? - A little.
- Want to smash something else? - Maybe.
Is that the best you can do? Here.
Yeah, that's it.
That's it.
Let me see you write your name.
- What are you doing? - I'm trying to help.
I'm tired of people trying to help me all the time.
People try to help too much sometimes? I don't need to be pushed around.
I don't need to have my food cut.
I don't need my mom to give me a freaking bath all the time.
I'm not a baby.
No, you're not.
I'm gonna go talk to your mother.
- Why don't you clean this up? - Me? You helped me make the mess.
You help me clean it.
Okay.
- It's okay, honey.
- There.
No more.
- Luka, I need to talk to you.
- Hold on.
It'll take a second.
Okay.
I'll be right back.
Good boy.
Good boy.
Yeah.
Good boy, honey.
I tried contacting his pediatrician.
He doesn't have one, which seemed weird to me for a kid this sick.
I called Northwestern, Rush, Mercy.
He's been admitted to all three ERs.
- Several times, multiple admissions.
- I know.
I've seen the scars.
He needed surgery once for his fundoplication.
All the rest were exploratory procedures.
He has a metabolic disorder and is at high risk for obstruction.
Nobody has documented anything.
I know.
But something's making him sick.
- You thought about the mother? - What about her? Maybe she's inducing his symptoms.
She wants to find out what's wrong with him.
- Maybe she likes the attention.
- She'd hurt her child? - I've seen parents do it before.
- Okay.
How? - I don't know.
- You can't say this without proof.
What if his upper GI is negative? CT shows nothing? Are you gonna admit him for surgery? I just started the work-up.
Let me figure it out.
- Would you just consider it? - Yeah.
Okay.
- He's fine.
- He's being abused by his classmates.
- He has to fight back.
- That's not a solution.
Look, Dr.
Finch, my son's short.
So what? I'm short.
And, yeah, I got picked on.
I dealt with it.
So will he.
By injecting himself with God knows what? That won't happen again.
I can assure you.
Dr.
Finch, Marty spiked a fever of 103.
- How are you feeling? - Crummy.
What do you expect? - Have you had a fever recently? - He had the flu.
There's a pansystolic murmur.
- What? - Has he had a heart murmur? - No.
- He's got splinter hemorrhages.
- What's going on? - Get blood cultures pentox and gent.
- Order a cardiac echo.
- Something's wrong with my heart? The needle may have put bacteria into your blood causing an infection of your heart.
Mr.
Spencer? I'm Abby Lockheart.
- I need a private room.
- We don't have any.
With this flu epidemic, this place is a big petri dish.
- Take a deep breath? - What if somebody comes in with TB? - What's the problem? - My pulse is thready.
- Really? - My chest feels tight.
I'm fatigued.
My head's pounding and I can barely hear anything.
- Do your stools glow in the dark? - What? - Your ears are full of wax.
- Oh, man! You can get that from food additives or toxins.
- I can clean them out.
- How? - I never put anything in my ears.
- We use a drill.
- A drill? - I'm kidding.
I use peroxide.
- Mrs.
Brant? Radiology is ready.
- Okay.
Okay.
Here we go, sweetie.
- I think I need an EKG.
- Carol, where's the EKG machine? Try Trauma.
Need me to draw labs? No.
I got it.
- We can wheel him out.
- I'd rather carry him.
Okay.
Sure.
I'm still on shift downstairs.
Should've considered that before turning the ER into O.
R.
- I'm not doing- - It won't kill you to observe! You still need to learn.
Somebody turn down the heat! - It's 68 degrees.
- Maybe it's the flu.
- I don't get sick.
- Is it the change? - DeBakey clamp.
- I can finish up.
I would like you to shut up while I save this man's life.
Suction.
What did you find? - The study was negative.
- So, what do we do now? - We should do a CT scan.
- What about endoscopy? I don't want to put your son through an unnecessary invasive procedure.
I feel we're wasting time.
Shouldn't a surgeon see him? After the scan.
- Sat's down to 78.
- Put him on 100% nonrebreather mask.
Anything else I can do to make you more comfortable? My lunch box.
This? There's $118 in there.
- Give it to my friends.
- Do you want it to go to a shelter? No.
Just throw it off the roof.
- Throw the money off the roof? - Yeah.
They'll find it.
- Conner's GI series was negative.
- You seem surprised.
I was hoping to find something wrong with him.
She wants an endoscopy.
She was disappointed when I wanted to wait.
And I think you might be right.
- Is this gonna hurt? - No.
It's just peroxide.
- You might feel a few bubbles.
- Bubbles? - What if they get into my blood? - That won't happen.
I'll be back.
- What about my chest? - EKG was normal.
Maybe I should have a stress echo.
That's not necessary.
What is the sense of sophisticated technology if you die before you get a chance to use it? Hey! - Sorry about that.
- That's okay.
- How's he doing? - Well, not so good.
Lots of tests and they don't know what's wrong.
- I'm sure Dr.
Kovac is being- - Did he call for a surgical consult? - I don't know.
I could check.
- Would you? Sure.
Another 30 Prolene.
Get that rake out of my way, please.
Oh, man! - Sure you're okay? - Yes.
You're over-sewing the duodenal defect.
There's no substitute for precision.
Lizzie, joining the party? - Mr.
Barnes eroded his aortic graft.
- Is he a friend? I thought he had gastroenteritis.
Peter didn't mention that.
How valiant of you to not rat Lizzie out on her gross oversight.
- How's he doing? - Fine.
Now that he's been diagnosed.
Lizzie, scrub in.
- I'm off.
- You're not anymore.
I'm gonna dissect the small bowel off the aorta now.
- You should use a Metz.
- I'd quit while- - Damn it! - Robert? I'm fine Robert? He's burning up! Let's get Metz and pick-up.
Get a gurney! He's got a weak pulse! Suction.
30 Prolene.
Let's get ready.
Not afraid you'll catch cold? No.
They're not stacking up again, are they? It's over.
Figure out what was wrong with that kid? Got tired of being short.
Injected himself with hormones.
- Why didn't I think of that? - Vegetations on his valve.
Endocarditis? He used Grandma's insulin needles.
- What did Cardiology say? - They put him on antibiotics.
Hopefully, he won't need surgery.
- All of that for a couple of inches.
- Yep.
- You're releasing too early.
- Why don't you show me? - You don't want any of this.
- I don't? Okay.
Show me what you got.
- What is it? - His stomach is distended! - Get me a syringe.
- I told you to call a surgeon! - What? What are you doing? - Hold on.
What's that? Is he bleeding? No.
Indicator mixed with saline.
Turns red in the stomach acid.
What are you talking about? That's not mine.
That belongs to the doctor or nurse, she left it here.
Actually, we had her leave it.
It's not peroxide.
It's saline.
- What are you talking about? - You know.
You've been poisoning him.
Security- Stop! I didn't give you permission.
We are leaving! I'm afraid you are not.
I can't allow this.
I love Conner.
I would never hurt him.
Mrs.
Brant, you need help.
Sweetie, it's okay.
It's okay, sweetie.
They're not gonna hurt you.
Mommy has you.
Mommy has you.
It's okay.
Call Transport.
Mr.
Clayton has to go to the morgue.
- That old guy died? From the flu? - Put him into respiratory failure.
I should've gotten that flu shot.
- Someone give you a tip? - He had a daughter.
- Who? - He told me he had no family.
- You're the executor of his estate? - Yeah.
- Hey, Abby.
- Hey.
Residents have to take students out for a drink.
- Thought you were sick.
- You could nurse me Whoa! Wow! You look- Wow! You know- - Did you have a hot date? - Maybe.
- You're drooling on my chart.
- Sorry.
So, yeah.
How about that drink? You're kidding, right? - How's he doing? - He has a kidney stone.
- You're kidding.
- Not big enough.
He won't need surgery.
That can't be a lot of fun.
Thanks for covering for me.
I appreciate it.
- Anybody could've missed it.
- My mind was elsewhere.
- So, you're going in to gloat? - Oh, yeah.
I wouldn't take glee in this.
I just came to tell you that Mr.
Barnes is stable in Recovery.
Good thing I was observing.
This means I owe you something.
- I'll settle for a thank you.
- How very gracious.
Thank you.
And the O.
R.
time for the girl's surgery.
You finished and closed for me.
Big deal.
How can you be against this? This is my job.
If I do favors for you, I have to do them for everybody.
Which is why we never had this conversation.
- That means I can have the O.
R.
? - I don't want to know about it.
- Good luck with that.
Thank you.
- You're welcome, Peter.
Abby, thanks for helping back there.
- She poured it down his G-tube? - Yeah.
- Ever part of a sting operation? - No.
Welcome to the ER.
Is Spencer your patient? - Yeah.
- He's having a heart attack.
What? Start him on dopamine.
- What happened? - He your patient? - Did you give him medication? - No.
BP, 70 palp.
- He complain of chest pains? - His EKG was normal.
Not anymore.
He's having an acute Ml.
No cardiac risk factor.
- HemoCue is six.
- He needs nitroglycerin and a drip.
- I'll start a second line.
- V-tach.
- Charge to 100.
- Synch cardioversion.
Chuny can get that.
Take those.
He's your patient.
Clear.
- Elizabeth.
- Hello, Mother.
- What are you doing here? - I live here, remember? Yes.
I meant to call you.
I just got in last week.
- Elizabeth, save me the pouty face.
- I'm not pouting.
I can't believe you didn't call me.
Yes.
Well, I'm here now.
And freezing.
If we're gonna talk, could we find somewhere warm? Preferably where they serve alcohol.
Or have the Americans banned that? Anyone ever tell you white men can't jump? - That was a foul.
- You tripped.
- You hip-checked me.
- Dr.
Greene? - What? - You said call if I had trouble.
Yeah.
Well He's a hypochondriac.
His tests were normal.
Mls don't always present symptoms.
You didn't get a blood count.
White count was 1800.
Crit was only 18.
What does that mean? - Aplastic anemia.
- Bingo.
Decreased oxygen-carrying capacity is a risk.
Hematology is gonna want to do a bone marrow biopsy.
- I'm sorry.
- No, I'm sorry.
I should've protected you more.
You gotta think like a doctor.
You don't have to do it all.
Make sure the nurses order your labs.
They have a standing order on CBCs.
- See you tomorrow.
- Okay.
I don't know how you keep your complexion here.
Nothing but wind.
- I don't work in construction.
- That's right.
You cut people up like your father.
How is Charles? Happy.
We had a lovely time when he was in town last.
- You know, Daddy stays at my place.
- How delightful! - Would you like to stay with me? - Whatever for? I have a spare room and I haven't seen you in three years.
- That's not my fault.
- I'd like you to come and stay.
- All right.
I agree.
- I'm honored.
- You look well.
You must have a man.
- Do I need a man to look well? It helps.
So, have you? - Yes.
- I suppose he is a doctor.
Actually, yes.
His name is Mark.
And he is lovely.
Come on, chicken! - We never finished.
- You were down by eight.
- I was pacing myself.
- Good night.
Quitter.
All right.
Bring it on.
Good night, Mark.
Nice hat.
- Hi.
- Hi.
- You're the new med student? - Abby Lockheart.
- Lucy.
- Nice to meet you.
- How was your first day? - I haven't had one of these in years.
- What happened? - It's more like what didn't happen? I used to work in OB.
Up there, I would deliver a baby and I would deliver a baby.
And today, I was puked on, spit at, bit And then I tricked a psychotic woman.
- And then I almost killed a guy.
- That sounds about right.
Fortunately, in the ER, "almost" doesn't count.
- What are you doing? - Patient's last request.
Toss some.
You might feel better.
- Do you have to say a prayer? - I don't think so.
R Previously on E.
R.
I'm Abby.
I'll be your OB nurse.
I just can't lie about a diagnosis.
Sometimes we make what's call a judgment call.
If the rules need to bent a little, then we bend them.
You wanna go grab some dinner? Peter, you asked me out? It's never been very easy for me to be here.
That's something I know about.
E.
R.
6x12 "ABBY ROAD" One minute I'm freezing, the next I'm burning up.
I can't keep things down.
Sir, it's the flu.
It's going around.
I got body aches, nasty cough.
I really need to see a doctor.
- Sit, we'll get to you in a minute.
- You said that an hour ago.
- I need to go home.
- Forget it.
We're shorthanded.
- I puked.
I gotta go.
- So did half the Radiology techs.
- I've got a fever.
Feel my head.
- Feel your own.
- Cold and flu season has hit hard.
- Yes, take your pick.
Fever, sore throats, runny noses aches and vomiting.
Why don't they go home? - It's coming out both ends.
- Thanks, Dave.
The lab is full.
It takes four hours to get a CBC.
They're 40 behind.
- You look bad.
- I look better than I feel.
No beds, we're boarding 7 patients.
Carol called in 2 registry nurses.
God only knows when they'll get here.
You should see a doctor.
Me too, or I'll expose the patients.
Take some Imodium.
Wear a mask.
- You touch the thermostat? - I just cleaned it.
- Hello, Mark.
- Good morning.
- Did you run the faucets? - Yes, it was freezing.
I had to boil water to wash my hair.
- I need a plumber.
- Let me look at it again.
A plumber will try to sell you a new one.
It's old, not dead.
What? - Kovac is fixing your water heater? - Trying to fix it.
He was dropping me off.
From work.
I was complaining it was making some noise- - Why am I explaining? - Beats me.
- Don't think that.
- Think what? - It's not that.
- It's not what? It's not anything.
- Move back, now.
- Coming through.
- If you've got the flu - Hi.
is too late for a flu shot.
- I'm Abby, they're expecting me.
- ER, please hold.
Please hold.
Abby.
- Did they send you here? - Yeah.
I was wondering when we were gonna get some help.
- Carol.
- Hathaway! - You were my OB nurse.
- Twins.
How are they? They sleep well, just not at the same time.
How do you do it? Not easy, but neither is managing 36 patients.
- Actually- - Coming by! I found this guy.
He can't walk.
- What's open, Carol? - If you can find a bed, grab it.
- Sorry.
- Call Housekeeping! Med students think we're their maids.
We're swamped.
- Actually- - Chest film for Mr.
Sranski.
- Sranski? - Flu patient.
- You need scrubs.
- No.
I don't think- - Haleh, do we have scrubs? - I don't care.
We do get along.
- You believe in zombies? - What? Human cadavers walking the earth after they've died? - No.
- There's a body still in Exam 1.
- I called Transport.
- Piggyback it out.
I need the bed.
- Residents, worse than students.
- Right.
Can somebody take this? - Did you call ahead? - Yes.
Todd Sullivan.
Good vitals.
He crashed while sledding.
- I lost my teeth.
- Don't worry, they're your baby teeth.
- Malik, can you call a doc? - Right.
Good luck.
He needs a C-spine and a head CT.
- We need a doc to order it.
- I can do it.
- What? - Students work on patients, right? - I'm a 3rd-year.
This is my rotation.
- A med student? Yes.
What can I say? I crossed over to the dark side.
Films are clear.
I paged an oral surgeon.
- Update his tetanus? - He had it last year.
- I guess not.
I'm Luka Kovac.
- Abby Lockheart.
I'm a third-year.
Another new Resident? - I'm a med student.
- Another half gram of Ancef? - Abby? - Sure.
Sounds good.
Okay.
Nice job.
We never had doctors like that in OB.
- Easy on the eyes? - I'll say! Is he single? He doesn't talk about it.
Tall, dark, handsome and mysterious? - What are you doing? - Cleaning.
- I got it.
- Don't be silly.
Really, I got it.
Okay.
Carol.
- Can I see pictures of your girls? - Sure.
He has to take his pills every day.
- He forgets.
- Maybe you can remind him.
I forget.
Put a note on your medicine cabinet to remind you.
That's a good idea.
I'll try to remember that.
I'm feeling horrible.
Can you cover my shift? - Must be bad if you're sick.
- I'd rather die at home.
Make sure the new student doesn't kill anyone.
- Leave her alone.
Abby- - Give me a break.
Suck it up.
Abby, meet Mark Greene, Attending.
- We've met.
- Yes.
See you tomorrow, if I live.
- She wasn't wrong? - I'm a med student.
- And an OB nurse.
- I do it to pay the bills.
Right.
Welcome to the glorious ER.
- Has anyone given you the tour? - No.
Start by signing up for your patient.
Grab a T-sheet based on complaint.
Nurses' orders go here.
- Labs and x-rays go here.
Questions? - So far, so good.
That's Curtain Area 1.
This is Area 2.
Yosh Takata.
- Wave hi to Yosh.
- Hi.
- Trauma 1, Trauma 2.
Haleh- - We've met.
- Hi.
Still hurting, Todd? - A little.
We gave him 4 morphine.
Can we give him 2 more? - Yes.
You need this tour? - It helps.
Come on.
The tram doesn't stop.
Keep your hands and arms inside.
What's this? Darnel Smith has muscular dystrophy.
Possible forearm fracture.
- What happened? - I was pushed down the stairs.
- In your wheelchair? - Duh! - It was a fight.
Cleo has the pusher.
- Let's keep the two of them apart.
- That's Carter.
- Yes.
This is the Pedes ER.
It's a large exam room with pediatric equipment and murals.
- Hey, Cleo.
- Hey.
He freaked out on me in the hallway when I tried to get past him.
You can't push him down the steps in a wheelchair.
I didn't push the psycho until he stabbed me with his pencil.
- What are you looking at? - Don't be rude.
Good news.
His arm's not broken.
I can't believe one of his classmates would do this.
I heard that he provoked it.
- Darnel, is that true? - No.
- He's been acting up lately.
- Is he in special education? No, he's not.
We wanted his life to be as normal as possible.
Got cancer? They'll cut off your penis.
- That's enough.
- Darnel! He's kidding.
- Mrs.
Henry, please wait in Chairs.
- Leave him here? I still need to check him.
All right.
You behave yourself.
I'll be right out in the waiting room if you need anything.
Darnel, sounds like you're having a little trouble in school.
Is this because of your muscular dystrophy? So, suddenly you don't speak.
I can't feel my toes.
You have frostbite.
Do we need to débride? - Is he a diabetic? - No.
He has a respiratory infection.
The frostbite is superficial.
Start him on a rapid rewarm - of 105 degree circulating water.
- Thanks.
Is anybody not sick? It's like the damn plague here.
Are you here to help? It's natural selection.
An epidemic thins the herd.
Where's Kerry? - She went home sick.
- That's why they're the weaker sex.
You booked an O.
R.
for 3:00? Yes.
I'm assisting Dr.
Ashcoff on a facial-scar revision.
- Can't that be done in the Plastics? - He wants general.
How do you fit in? The girl's my patient.
I'm following up on a dog bite.
Yeah, so? Medicaid won't cover it.
I got Ashcoff to donate his time.
I was- We provide medical services to the poor.
Well, that does not include cosmetic surgery.
What's next, liposuction for fat kids? - A little girl is disfigured.
- Peter, I admire your noble effort.
But this kind of thing could lose our state funding.
I'm sorry, big guy.
Will I get lead poisoning from the pencil? - Pencils are graphite.
- Temp's 99.
2.
- Did that hurt? - No.
It's just cold.
Sorry.
- How did you get these bruises? - I don't know.
Who hit you, Marty? - Some kids at school.
- Are you sure? Yeah, I'm sure.
- Do your parents know about this? - No.
- The teachers or the principal? - They'll kill me.
What's this? - Mosquito bites.
- In February? They must be hungry.
You have quite a few.
Look, is my dad coming? He's on his way.
I'll be back.
Get a CBC, Chem-20, and a tox screen.
They're infected track marks.
- What am I looking for? - Top of page 4.
It was a good morning.
- I spotted it while reading the paper.
- What? For Pete's sake! "University of Chicago, Department of Astrophysics will present a symposium.
Guest speakers include" - Isabelle Corday.
Your mother.
- Yes! - I see the resemblance.
- I look like my father.
You didn't tell me.
I didn't know.
It's so like her.
- You guys having a fight? - No, she's just being Mother.
You should call her.
Of course, come to her, that's part of the game.
- Or don't call her.
- I won't.
I'm not playing.
Get off me! I'll kill you! I'll kill you! - Was he trying to hurt himself? - No, he's freaked out.
- On medication? - Drugs! - Looks like PCP to me.
What happened? - He jumped out a third-story window.
He didn't even feel it.
He'll feel something soon.
Get out! - What are you doing? - He needs to see this.
Listen, we're trying to help.
He's broken both legs, exposed bone.
- Ever seen an open fracture? - No.
He's taching away.
Pulse is strong.
Ten of Haldol, IM.
Get those restraints on.
Get that out of here! - Please back up.
- No, this is too good.
- Now! - CBC, tox screen, UA and a myoglobin! - Haldol now! - Restraints or Haldol? - I got it.
- Tetanus booster and a gram of Ancef! Okay, roll him.
Give it in the thigh interior.
- You okay? - Yeah.
Set me up for P.
M.
splints! - You've had Heptovax? - Yes, but patients don't bite in OB.
It's an occupational hazard down here.
Serologies will be back tomorrow.
Don't sweat it.
You're your own teaching case.
Well, I expected the ER to be different.
Stop squirming and I'll get it in.
- You're being rough.
- Stop whining.
Be glad she's not putting in a Foley.
Once you've been bitten by a raving lunatic, you're ready to see patients.
I don't know.
Grab a chart.
And yell if you get into trouble.
- Carol, keep an eye on her? - Sure.
Oh, and update her tetanus.
Press on my hand like you're stepping on the gas.
That's good.
Let's do the other foot.
You do much driving, Darnel? Okay.
Okay.
Now I want you to squeeze my hand.
If you make me scream, I'll give you a prize.
- Give me a break.
- He speaks! Okay, come on.
I wanna see how the MD's affecting your body.
Duchenne's muscular dystrophy is a genetic disorder characterized by the wasting of skeletal muscles.
First you lose your legs, then your arms, and then you die.
That's how it's affecting my body.
- Hold his head still.
- I'm sorry.
He really hates hospitals.
Don't be afraid.
We wanna make you better.
He's good-natured, considering what he's been through.
What surgery has he had? A Nissen fundoplication for gastroesophageal reflux.
A hemicolectomy, and a few laparotomies.
- When was he vomiting? - Today.
Mucous membranes are moist.
Did you feed him orally, or in his G-tube? I gave him a little by mouth.
But not enough to induce this.
I pray it's the flu.
But it may be a bowel obstruction.
Abby, can you get this foreign body ingestion? - Sure.
Just a sec.
- Luka? Can I steal Abby? We're backed up.
It's okay.
Go ahead.
So, what do you think it is? I'm not sure.
I'm gonna have to take some x-rays.
Carol, can I get a weight and a three-way abdominal series? - You dehydrated? - How'd you guess? Jeremy Barnes.
Abdominal cramping, some diarrhea.
A fever with a history of a triple-A.
- How are you feeling, sir? - Lousy.
- Any vomiting? - No.
I feel real nauseous.
- When was your aneurysm repaired? - A year ago.
- Any complications? - No complications.
- I felt great until this.
- It's just the flu.
- Thank you.
- You're welcome.
Maybe he's telling the truth.
School can get rough.
He has skin-popping abscesses.
- You get a tox screen? - It's negative.
He's clean.
- You can't be sure.
- What are you thinking? I don't know.
But maybe you can bluff it out of him.
- You okay? - Somebody stole my patient.
- Peter, did you steal Lucy's patient? - Check the lost and found.
Dr.
Benton? - Hi.
- Mrs.
Fulton.
I took Tia to surgery.
The nurse said she can't have her operation today? I tried to call you.
Please, have a seat.
- There's no availability in the O.
R.
- Dr.
Ashcoff change his mind? No, no, no.
We just have to reschedule.
Well, we came all the way down here.
We can wait.
- Tia hasn't eaten in eight hours- - We can't do it today.
I'm sorry.
I'm not gonna get them fixed? You've waited long.
A few more days won't hurt.
Hold on a minute, honey.
Can we? It has taken me months to get Tia out of the house.
I can't give her false hope.
If this isn't gonna happen you need to tell us.
It's gonna happen.
I just need a little time.
Thanks.
Mr.
Barnes needs Compazine, run saline through and check his electrolytes.
Can't you get a nurse to do that? - You used to be one.
- I'm not now.
You're here to learn.
This is an opportunity to learn how to check his stool for fecal leukocytes.
Thanks.
- What's his pulse ox? -82.
- And how much oxygen is he on? -10 liters.
The flu is making it difficult to breathe.
It ain't just the flu.
No.
You also have congestive heart failure.
A tube will help you breathe.
No.
Thank you.
- Do you have someone we can call? - No.
All my friends is homeless.
No phones.
- Any family? - No.
Okay.
I really think you need to go on a ventilator.
No.
Thank you.
I always hoped I might die in a warm bed with clean sheets, if it's all the same to you.
X- rays show nonspecific bowel gas pattern.
- So, it's not another adhesion? - Right.
Blood gas is back.
PH is 7.
38.
PCO-2 is 30.
Is it respiratory alkalosis? Partly.
But also an acidosis.
It's complicated.
- Are you a nurse? - No.
I've read every book on chalazia.
- Did they do an upper GI? - Six months ago.
They thought he had a gastric outlet blockage.
You're not gonna do that? - It'll rule out an obstruction.
- No, please.
They put an NG tube up his nose.
He wouldn't stop crying.
I know he's been through a lot.
He has a metabolic disorder.
We have to find out why he's sick.
I will be as gentle as possible.
Okay? Okay.
I'll be back.
- What? - You tell me.
Nothing.
We tested your blood, Marty.
Yeah? So? - Where do you get the dirty needles? - What do you mean? Marty, I know.
You can't tell my dad.
Please.
He won't understand.
You can't use dirty needles.
You're infected and if you share, you could get HIV.
Don't worry.
I stole them from my grandmother.
She's got diabetes.
- Why do you do it? - Kids with crooked teeth get braces.
My mom got laser surgery on her eyes.
Why can't I use hormones? - For what? - To grow taller.
You're injecting human growth hormone? Where do you get it? - It's not illegal.
- Where do you get it, Marty? - Off the Internet.
- Then you don't know what's in it.
Do you know the health risks you've been exposed to? It can't be worse than being beat up.
Even that stupid kid in the wheelchair picks on me.
If you can get me the real stuff, I- Hormone therapy is not for healthy adolescents.
Well, I'm not healthy.
I go to school every day knowing that I'm gonna be beat up or shoved into a locker, or dragged into the girls' shower room.
Do you know how embarrassing it is to be stuffed inside a trash can while the whole cafeteria's laughing at you? Hormones aren't going to help that.
Yeah? Well, being bigger will.
- Hey.
- Hi.
- You okay? - Yeah.
- Have you seen the Cetacaine? - No.
- We always keep it on this counter.
- Sorry.
Carol? Are you uncomfortable with my being here? Why would I be? It's hard for nurses when nurses go to med school.
I switched teams.
I'm gonna be sick.
Actually, I almost went to med school myself.
- Is it something else? - It's just stupid.
Oh, my God! - Have you had an ulcer? - What's wrong with him? I don't know.
I'll get a doctor.
- I need a Yankauer.
- Top drawer.
Peter! I'm gonna start a line.
Check his BP.
He just started vomiting bright red blood.
- What's the history? - Looks like triple-A.
- Ulcer, I think.
- Think? - He's not my patient.
- Okay, here we go.
Set me up for a central line.
Squeeze in two liters.
Get me four units O-neg.
- What's wrong? - Bleeding through his GI.
- Call the O.
R.
- What happened? - Aorto-enteric fistula.
- Should we take him? - Just tube him.
-80 ET.
- Damn it! - Now! - Why is he here? - Corday said it was the flu.
- His pulse is weak.
BP's 50 palp.
- We need to stop the bleeding.
- What's your name? - Abby.
- Can you sew this? - Yes.
A suture? As long as it doesn't pull away.
- Prep him for a lap.
- You can't do one here- No choice.
Scalpel! I'll make a small midline incision, and clamp below the diaphragm.
- Got that? - Almost.
All right.
Let's go.
- Pressure's at 90.
- This should hold him.
Tell the O.
R.
we're coming.
- Two units of O-neg in.
- Operating in the ER, Peter? - He had an aortal-enteric fistula.
- Why isn't he in surgery? - He had flu symptoms.
- Look like the flu, Malatucci? - Malucci.
No.
But Dr.
Benton- - Save it for the disciplinary hearing.
Let's get him to O.
R.
before you use the rest of our blood supply.
You got to admit, that was pretty cool.
- Can I go home now? - Not just yet.
- I want you to try something first.
- What? - Computer.
- I've seen one or two.
Maybe the MD's affecting your motor skills and causing trouble at school.
- Wrong.
- You can keep up with other kids.
The school is full of losers.
Oh, well.
Come on, just give it a try.
Oops! - Feel better? - A little.
- Want to smash something else? - Maybe.
Is that the best you can do? Here.
Yeah, that's it.
That's it.
Let me see you write your name.
- What are you doing? - I'm trying to help.
I'm tired of people trying to help me all the time.
People try to help too much sometimes? I don't need to be pushed around.
I don't need to have my food cut.
I don't need my mom to give me a freaking bath all the time.
I'm not a baby.
No, you're not.
I'm gonna go talk to your mother.
- Why don't you clean this up? - Me? You helped me make the mess.
You help me clean it.
Okay.
- It's okay, honey.
- There.
No more.
- Luka, I need to talk to you.
- Hold on.
It'll take a second.
Okay.
I'll be right back.
Good boy.
Good boy.
Yeah.
Good boy, honey.
I tried contacting his pediatrician.
He doesn't have one, which seemed weird to me for a kid this sick.
I called Northwestern, Rush, Mercy.
He's been admitted to all three ERs.
- Several times, multiple admissions.
- I know.
I've seen the scars.
He needed surgery once for his fundoplication.
All the rest were exploratory procedures.
He has a metabolic disorder and is at high risk for obstruction.
Nobody has documented anything.
I know.
But something's making him sick.
- You thought about the mother? - What about her? Maybe she's inducing his symptoms.
She wants to find out what's wrong with him.
- Maybe she likes the attention.
- She'd hurt her child? - I've seen parents do it before.
- Okay.
How? - I don't know.
- You can't say this without proof.
What if his upper GI is negative? CT shows nothing? Are you gonna admit him for surgery? I just started the work-up.
Let me figure it out.
- Would you just consider it? - Yeah.
Okay.
- He's fine.
- He's being abused by his classmates.
- He has to fight back.
- That's not a solution.
Look, Dr.
Finch, my son's short.
So what? I'm short.
And, yeah, I got picked on.
I dealt with it.
So will he.
By injecting himself with God knows what? That won't happen again.
I can assure you.
Dr.
Finch, Marty spiked a fever of 103.
- How are you feeling? - Crummy.
What do you expect? - Have you had a fever recently? - He had the flu.
There's a pansystolic murmur.
- What? - Has he had a heart murmur? - No.
- He's got splinter hemorrhages.
- What's going on? - Get blood cultures pentox and gent.
- Order a cardiac echo.
- Something's wrong with my heart? The needle may have put bacteria into your blood causing an infection of your heart.
Mr.
Spencer? I'm Abby Lockheart.
- I need a private room.
- We don't have any.
With this flu epidemic, this place is a big petri dish.
- Take a deep breath? - What if somebody comes in with TB? - What's the problem? - My pulse is thready.
- Really? - My chest feels tight.
I'm fatigued.
My head's pounding and I can barely hear anything.
- Do your stools glow in the dark? - What? - Your ears are full of wax.
- Oh, man! You can get that from food additives or toxins.
- I can clean them out.
- How? - I never put anything in my ears.
- We use a drill.
- A drill? - I'm kidding.
I use peroxide.
- Mrs.
Brant? Radiology is ready.
- Okay.
Okay.
Here we go, sweetie.
- I think I need an EKG.
- Carol, where's the EKG machine? Try Trauma.
Need me to draw labs? No.
I got it.
- We can wheel him out.
- I'd rather carry him.
Okay.
Sure.
I'm still on shift downstairs.
Should've considered that before turning the ER into O.
R.
- I'm not doing- - It won't kill you to observe! You still need to learn.
Somebody turn down the heat! - It's 68 degrees.
- Maybe it's the flu.
- I don't get sick.
- Is it the change? - DeBakey clamp.
- I can finish up.
I would like you to shut up while I save this man's life.
Suction.
What did you find? - The study was negative.
- So, what do we do now? - We should do a CT scan.
- What about endoscopy? I don't want to put your son through an unnecessary invasive procedure.
I feel we're wasting time.
Shouldn't a surgeon see him? After the scan.
- Sat's down to 78.
- Put him on 100% nonrebreather mask.
Anything else I can do to make you more comfortable? My lunch box.
This? There's $118 in there.
- Give it to my friends.
- Do you want it to go to a shelter? No.
Just throw it off the roof.
- Throw the money off the roof? - Yeah.
They'll find it.
- Conner's GI series was negative.
- You seem surprised.
I was hoping to find something wrong with him.
She wants an endoscopy.
She was disappointed when I wanted to wait.
And I think you might be right.
- Is this gonna hurt? - No.
It's just peroxide.
- You might feel a few bubbles.
- Bubbles? - What if they get into my blood? - That won't happen.
I'll be back.
- What about my chest? - EKG was normal.
Maybe I should have a stress echo.
That's not necessary.
What is the sense of sophisticated technology if you die before you get a chance to use it? Hey! - Sorry about that.
- That's okay.
- How's he doing? - Well, not so good.
Lots of tests and they don't know what's wrong.
- I'm sure Dr.
Kovac is being- - Did he call for a surgical consult? - I don't know.
I could check.
- Would you? Sure.
Another 30 Prolene.
Get that rake out of my way, please.
Oh, man! - Sure you're okay? - Yes.
You're over-sewing the duodenal defect.
There's no substitute for precision.
Lizzie, joining the party? - Mr.
Barnes eroded his aortic graft.
- Is he a friend? I thought he had gastroenteritis.
Peter didn't mention that.
How valiant of you to not rat Lizzie out on her gross oversight.
- How's he doing? - Fine.
Now that he's been diagnosed.
Lizzie, scrub in.
- I'm off.
- You're not anymore.
I'm gonna dissect the small bowel off the aorta now.
- You should use a Metz.
- I'd quit while- - Damn it! - Robert? I'm fine Robert? He's burning up! Let's get Metz and pick-up.
Get a gurney! He's got a weak pulse! Suction.
30 Prolene.
Let's get ready.
Not afraid you'll catch cold? No.
They're not stacking up again, are they? It's over.
Figure out what was wrong with that kid? Got tired of being short.
Injected himself with hormones.
- Why didn't I think of that? - Vegetations on his valve.
Endocarditis? He used Grandma's insulin needles.
- What did Cardiology say? - They put him on antibiotics.
Hopefully, he won't need surgery.
- All of that for a couple of inches.
- Yep.
- You're releasing too early.
- Why don't you show me? - You don't want any of this.
- I don't? Okay.
Show me what you got.
- What is it? - His stomach is distended! - Get me a syringe.
- I told you to call a surgeon! - What? What are you doing? - Hold on.
What's that? Is he bleeding? No.
Indicator mixed with saline.
Turns red in the stomach acid.
What are you talking about? That's not mine.
That belongs to the doctor or nurse, she left it here.
Actually, we had her leave it.
It's not peroxide.
It's saline.
- What are you talking about? - You know.
You've been poisoning him.
Security- Stop! I didn't give you permission.
We are leaving! I'm afraid you are not.
I can't allow this.
I love Conner.
I would never hurt him.
Mrs.
Brant, you need help.
Sweetie, it's okay.
It's okay, sweetie.
They're not gonna hurt you.
Mommy has you.
Mommy has you.
It's okay.
Call Transport.
Mr.
Clayton has to go to the morgue.
- That old guy died? From the flu? - Put him into respiratory failure.
I should've gotten that flu shot.
- Someone give you a tip? - He had a daughter.
- Who? - He told me he had no family.
- You're the executor of his estate? - Yeah.
- Hey, Abby.
- Hey.
Residents have to take students out for a drink.
- Thought you were sick.
- You could nurse me Whoa! Wow! You look- Wow! You know- - Did you have a hot date? - Maybe.
- You're drooling on my chart.
- Sorry.
So, yeah.
How about that drink? You're kidding, right? - How's he doing? - He has a kidney stone.
- You're kidding.
- Not big enough.
He won't need surgery.
That can't be a lot of fun.
Thanks for covering for me.
I appreciate it.
- Anybody could've missed it.
- My mind was elsewhere.
- So, you're going in to gloat? - Oh, yeah.
I wouldn't take glee in this.
I just came to tell you that Mr.
Barnes is stable in Recovery.
Good thing I was observing.
This means I owe you something.
- I'll settle for a thank you.
- How very gracious.
Thank you.
And the O.
R.
time for the girl's surgery.
You finished and closed for me.
Big deal.
How can you be against this? This is my job.
If I do favors for you, I have to do them for everybody.
Which is why we never had this conversation.
- That means I can have the O.
R.
? - I don't want to know about it.
- Good luck with that.
Thank you.
- You're welcome, Peter.
Abby, thanks for helping back there.
- She poured it down his G-tube? - Yeah.
- Ever part of a sting operation? - No.
Welcome to the ER.
Is Spencer your patient? - Yeah.
- He's having a heart attack.
What? Start him on dopamine.
- What happened? - He your patient? - Did you give him medication? - No.
BP, 70 palp.
- He complain of chest pains? - His EKG was normal.
Not anymore.
He's having an acute Ml.
No cardiac risk factor.
- HemoCue is six.
- He needs nitroglycerin and a drip.
- I'll start a second line.
- V-tach.
- Charge to 100.
- Synch cardioversion.
Chuny can get that.
Take those.
He's your patient.
Clear.
- Elizabeth.
- Hello, Mother.
- What are you doing here? - I live here, remember? Yes.
I meant to call you.
I just got in last week.
- Elizabeth, save me the pouty face.
- I'm not pouting.
I can't believe you didn't call me.
Yes.
Well, I'm here now.
And freezing.
If we're gonna talk, could we find somewhere warm? Preferably where they serve alcohol.
Or have the Americans banned that? Anyone ever tell you white men can't jump? - That was a foul.
- You tripped.
- You hip-checked me.
- Dr.
Greene? - What? - You said call if I had trouble.
Yeah.
Well He's a hypochondriac.
His tests were normal.
Mls don't always present symptoms.
You didn't get a blood count.
White count was 1800.
Crit was only 18.
What does that mean? - Aplastic anemia.
- Bingo.
Decreased oxygen-carrying capacity is a risk.
Hematology is gonna want to do a bone marrow biopsy.
- I'm sorry.
- No, I'm sorry.
I should've protected you more.
You gotta think like a doctor.
You don't have to do it all.
Make sure the nurses order your labs.
They have a standing order on CBCs.
- See you tomorrow.
- Okay.
I don't know how you keep your complexion here.
Nothing but wind.
- I don't work in construction.
- That's right.
You cut people up like your father.
How is Charles? Happy.
We had a lovely time when he was in town last.
- You know, Daddy stays at my place.
- How delightful! - Would you like to stay with me? - Whatever for? I have a spare room and I haven't seen you in three years.
- That's not my fault.
- I'd like you to come and stay.
- All right.
I agree.
- I'm honored.
- You look well.
You must have a man.
- Do I need a man to look well? It helps.
So, have you? - Yes.
- I suppose he is a doctor.
Actually, yes.
His name is Mark.
And he is lovely.
Come on, chicken! - We never finished.
- You were down by eight.
- I was pacing myself.
- Good night.
Quitter.
All right.
Bring it on.
Good night, Mark.
Nice hat.
- Hi.
- Hi.
- You're the new med student? - Abby Lockheart.
- Lucy.
- Nice to meet you.
- How was your first day? - I haven't had one of these in years.
- What happened? - It's more like what didn't happen? I used to work in OB.
Up there, I would deliver a baby and I would deliver a baby.
And today, I was puked on, spit at, bit And then I tricked a psychotic woman.
- And then I almost killed a guy.
- That sounds about right.
Fortunately, in the ER, "almost" doesn't count.
- What are you doing? - Patient's last request.
Toss some.
You might feel better.
- Do you have to say a prayer? - I don't think so.