ER s08e22 Episode Script
Lockdown
E.
R.
Previously on E.
R.
Mark's gone.
That means you've been here longer than any other doctor.
People will look to you to step in and fill the void.
Are you guys insane? I need to cross-clamp the aorta with that big-ass clamp.
You don't know what it's called, you shouldn't use it.
You wanna stay here, you do what I tell you, when I tell you.
It's that simple.
- No, thank you.
- Come on.
There's a meeting at 1.
- Great.
Go.
I'll catch up.
- When's the last time you went? - What do you think? - What's it gonna hurt? - It'll kill my buzz for starters.
- Come on, one step at a time.
You went for you or because you promised me you would? I went for you.
E.
R.
8x22 "LOCKDOWN" - Why is the dog bite still here? - I don't know.
- Waiting on his IV Unasyn.
- Any particular reason? Nurses aren't back from ACLS class yet.
The sooner he gets his meds, the sooner he gets discharged.
- I've done my share of IVs at the VA.
- There's no "I" in "team," Pratt.
- People really say crap like that here? - No.
But they should.
Dr.
Weaver on line one with a mouthful of marbles.
- What happened to her? - Chipped her tooth in Barbados.
I told her not to open bottles with her teeth.
So, Pratt, you wanna check orthostatics in Exam 3? - Why are you asking him? - I don't know.
He's got a cute ass? - We're down three nurses.
- Hey, we can help.
- Point is, why should we? - Let's all pitch in.
Pratt, check vitals.
Gallant, why don't you start IVs.
And I'll discharge Martinez here.
- All this because a nurse tells us to.
- Abby is the Obi-Wan Kenobi of nurses.
- So, what does that make you? Yoda? - Learn from her, you will.
Might have to separate these two.
Burns to the soles of the feet from hot coals.
- Fire walkers? - Lawyers.
- Why walk on hot coals? - It was a bonding exercise.
- We' re partners at the same firm.
- If I could walk, I'd kick your ass! - Would have worked if she hadn't pushed! - My feet were burning! - Anybody smell smoke? - Yeah, kind of.
- Of course you do.
We were charbroiled.
- No, it's - It's coming from your cuff! - Oh, my God! I'm on fire! Flames! Oops.
- This is not a hotel, Stan.
- I got the chills.
My teeth are rattling.
- I don't get no rest behind a dumpster.
- I have the flu.
You don't see me in bed.
I'd like to.
What about that Hippo oath you guys took? Do some good, be nice.
- Ask Dr.
Pratt.
He's handling you today.
- Is this because I'm new? - No.
Because you're annoying.
- Sure could do with a rubdown.
- Who wants the first tetanus shot? - Me, so I can get away from this moron.
You have to come back for wound-check tomorrow.
- Rather have my feet amputated.
- You don't have to do it together.
- Showers? - Don't have to do that together either.
That's fine.
Just pat the burns dry with a clean towel.
Dirty water running down to the foot increases chance of infection.
- How about the bathtub? - How about keeping them dry? How about y'all kiss and make up? Multiple MVA, two minutes out.
Marge Satterfield, bus driver of a gamblers' special, 50 altered at the scene.
- How's her airway? - Wide open.
Pulse ox, 98.
BP, 110/80.
You were in an accident, ma'am.
Let's take her to Trauma 1.
- Busload of senior citizens.
- How many do we have? - I'll work up this blunt head injury.
- First one out triages.
- Could be a hematoma.
- Next one might be worse.
Colin Prentice, 21, driver.
Head-on collision with the bus.
- Was he restrained? - Not very well.
Two-inch scalp lac.
- Broke the steering wheel.
- He driving a Matchbox? Worse, a Gremlin.
We intubated for a GCS 2-2-3.
BP, 120/70.
Pulse, 96.
- Trauma 2, let's go.
- Not by yourself.
Get Dr.
Lewis to help.
- How's Marge doing? Our driver.
- We don't know.
Ralph Meyers, 73.
Obvious forearm fracture with deformity.
- You having chest or belly pain? - No.
How will I play the slots? - Just use your other arm.
- I got another one for you, doc.
- Facial lac? - Broken glass.
Lenore Fong.
Neuro's intact.
- How old is she? - Got me.
Doesn't speak English.
- What'd she say? - "Rude to ask her age.
" Take her to Curtain 2.
Get it out of her, Deb.
Good.
That might be it.
Or not.
- Did you call the nurses from ACLS class? - They're all on a break.
Get some clerks or something.
We're dying down here.
- Can we have our aftercare instructions? - I'll be right with you.
- Miss, my colostomy bag is leaking.
- Just a minute, okay? - My family has been here for a long time.
- We got hit with a big accident.
- Both of my kids are sick.
- Someone will see them.
Yeah, we were here first.
I hope my passengers are okay.
They're all so old.
- No hemotympanum, toes downgoing.
- She need the O.
R.
? Nothing surgical so far.
Marge, any pain here? Good breath sounds bilaterally.
No tracheal shift.
- I gotta go.
- Not until you get a vent.
- Call for a C-spine, chest and pelvis.
- I don't know the numbers.
- Look at the phone list.
- Systolic's down to 80.
- Run in two liters wide open.
- This really isn't my job.
- It is today.
Feels like a pelvic fracture.
- Hello, this is Dr.
Pratt at the ER- - Please hold.
- Draw blood for a CBC and chem panel.
- I'm on hold.
- Type and cross for four.
- Find some O-neg.
- Got the SonoSite.
Oh, good.
I need to rule out intra-abdominal bleed.
- Chem panel goes in red top or green top? - Abby, help.
- Excuse me? - Go see if Kovac needs you.
- I need to start a dopamine drip.
- T op-right drawer.
- How's it going? - Might get more criticals.
Everybody's got multiple medical problems.
Is this 400 and 250? - It's a premix.
- Where's the head? - It's not in here.
- Then where? - No fluid in Morrison's pouch.
- Sir, you can't be in here.
- But I gotta take a whiz.
- Come with me.
Hang a left.
Can you call my daughter? Everybody move to the admit area so I can assess all of your injuries.
- Wanna see my bruises? - Not now.
- It hurts when I walk.
- Hey, Gallant, deal with this.
Listen, everybody proceed to the north.
We'll get you all taken care of.
- Where the hell is north? - All right, got the pressors.
- I thought she was hypertensive.
- Probably vagalled with the blood draw.
You could check him for compartment syndrome.
Why not? Can you wiggle your fingers? Damn foreigners ought to just get their own bus! - What'd she say? - "I had a fever.
" - And then something about his mother.
- Probably set the driver off, that gibberish.
- Marge was twitching, she was so mad.
- Twitching? - Like a Holy Roller.
- Excuse me.
- Might have had a seizure.
- After the accident? Before.
She have a medical alert bracelet? Check her wallet.
Mental status is consistent with a post-ictal state.
- I've got a couple of really sick kids.
- I'm busy right now.
- Half-load of phenytoin, send off levels.
- They had fevers a week ago - then developed a rash.
- No myoclonus.
- Pretty bad.
Think you need to see them.
- Go, Carter.
We got this.
- Sir, ma'am, this is Dr.
Carter.
- Okay, let's take a look.
We thought it was chickenpox, but I've never seen it as bad as this.
- Can you lift up her shirt? - It's not on her chest or her stomach.
Adam doesn't have it as bad.
- When did the rash start? - Three days ago.
- How long have you been waiting? - Too long.
Tried to tell that nurse, but she said it was busy.
Could it be an allergic reaction? No.
Would you excuse me? Get masks on them.
- Hey, what's up? - Where are the tubes? - What? - Those tubes with the posters in them.
Oh, those Public Health things? They should be over there, man.
Oh, man.
What? What's going on? Michael, would you go get Dr.
Lewis? Now! I'm gonna move you to a private room.
Can you take Adam? Follow me quickly.
- What is it? - It's just a precaution.
Excuse me.
Coming through here.
Can you move out of the way? - Why are we running? - Just stay with me.
Right up here.
- All right, stay here.
I'll be right back.
- What is going on? - Where is she? - Getting a central-line kit.
Susan, just come with me.
- I think I got two cases of smallpox.
- Oh, my God.
Firm, deep-seated pustules, all in the same stage of development.
- Just a bad case of chickenpox.
- Centrifugal distribution sparing the trunk.
It's all the major criteria.
We haven't had a case here since the '40s.
It's airborne.
We need to lock this place down.
Okay.
Elevator lobby, north stairwell, south corridor are all secure.
- Security's locking the ambulance bay.
- Is that a fire safety violation? - We' re closed.
- Is Public Health on the way? Do I call the State Department? - Check the emergency response plan.
- This is the plan.
- I don't know.
Call all three.
- Hey, hold on.
- Think you're jumping to conclusions? - You seen smallpox before? No, that's my point.
It could be anything.
Scabies, pityriasis, chickenpox.
- This is not chickenpox.
- Are you 100 percent certain? - You wanna risk exposure to the city? - Whoa! How bad is it? - Killed half of Europe.
- They have a vaccine.
- The CDC should have a stockpile.
- In Chicago? - Atlanta.
- Oh, great.
Luka's right.
Smallpox has been eradicated.
I heard the Russians had some on ice.
- If a terrorist group- - Shut up, Jerry.
Damn, I should have called in sick today.
- What? - Lock it down.
They're on their way.
- The entire hospital? - The ER.
- What do we do about critical patients? - You're asking me? - They're brother and sister.
- Yeah.
- Five and 10? - Yeah, why? I think I treated them last Tuesday.
They presented with the flu.
I have a fever.
- You need to be quarantined.
- Hey, slow down, guys.
Susan, you gotta come up with a plan now.
Okay, okay.
Deb, Carter's right.
You're quarantined to Exam 4.
Jerry, pull the staff schedule and patient log from last Tuesday.
Luka, re-assess all the patients, group the criticals.
- I'll take care of Public Health.
- What about the kids? Nobody panics.
Nobody starts any rumors.
This is just routine.
Then you better tell them why the doors are locked.
Carter, wait.
Do you know that family sat in Chairs for 45 minutes? - Should have been isolated.
- They would, had I seen them.
- Pretty hard to miss.
- We're down three nurses.
I told you.
- What are you doing? - If it's smallpox, it could get septic.
- Hope I'm not right.
- You'll need help.
Don't come if you're worried about exposure.
I've already been exposed.
Who's in charge? I got a cop telling me I can't go.
- Why are you detaining us? - I'm about to explain.
- If I don't get a cigarette, I'll go postal.
- Ma'am, please! - Okay, Jerry.
Does this thing still work? - It did in '95.
- What the hell is going on, huh? - Does this place even have a license? Sorry.
I'm Dr.
Lewis.
As you may have noticed there are guards posted at all the exits.
This is because we have a potential public health concern.
I would like to emphasize the word "potential.
" Because at present, we don't have any conclusive evidence.
City authorities are on their way to assist.
However, until we have more information we ask that no one enter or leave the department.
- What do you mean we can't leave? - This is purely a precaution.
When I know more, you'll know more.
Thank you for your patience.
- I want out of here! I'm getting out! - My wife is expecting me! Don't you understand? What kind of authorities are you talking about? - That helping? - Do I look like her? - Not as bad.
- Was anybody sick around you? - I don't think so.
- We were at the embassies, hotels.
- We stood out.
- Where? Central Africa.
Craig works for the State Department.
- When did you get back? - Two weeks ago.
Okay.
Okay, we need to keep you both in isolation.
- Why? - You could be incubating the virus.
- You probably both are.
- You said 10 to 14 days.
We need to know where you've been, who you've been with since your kids developed a fever.
- The kids were in school.
- They could get sicker? We need skin biopsies and smears to send to the CDC biocontainment lab.
- They could die? - We're being careful.
Nothing's confirmed.
Dr.
Carter.
Is she tachycardiac? I don't know, but you're freaking them out.
Slow down.
Hey, you okay? Biggest public health emergency of the century, and I'm stuck here.
Stuck? This is the damn Ritz if you ask me.
Sorry.
You got a roommate.
Oh, come on! Were you really here last Tuesday, Stan? Yeah, sure I was.
You know, they say this could be very serious.
I've had gastritis, hepatitis, pancreatitis.
A little pox is not gonna bother me.
- You got a temperature too? - Probably just a flu.
It's not smallpox.
It can't be.
It's just gotta be a mistake.
- County.
- How in the hell long is it gonna be? - Sir, I don't know.
- Will you pay for the hours I miss? - Gallant, how are the seniors? - Mostly sprains and contusions.
Thank God for small favors.
What about Public Health? En route.
But Chicago P.
D.
is here, with billy clubs and handcuffs.
Gee, I feel safe now.
Where do you think you're going? She needs a head CT.
She's not infectious.
Does she have a blown pupil? - No.
- Then she can wait.
- She's an older trauma patient.
- Do you know where you are? - Looks like a hospital.
A crappy one.
- I'd say she's pretty lucid.
Dr.
Lewis.
David Torres, Public Health.
We can take over now.
- The crisis or the patient care? - This is for contact tracing.
- And this is for you.
- Okay.
The CDC will be flying in from Atlanta.
We need this area for our staff.
Dr.
Torres, I'm down in Engineering.
First and second floor share ventilation.
- Kill the a.
c.
- It's 80 degrees outside.
Welcome to the hot zone.
May I see the infected kids, please? No, the infection's in the bloodstream, which makes the lungs leak fluid.
- But she's been responding to oxygen.
- We never should have been there! You could have stayed home.
And your children don't see you for a year! If there was an outbreak, we'd have heard.
Craig, we were targets.
A maniac is using this as a weapon.
- There are a lot of unknowns.
- There's something wrong with Bree.
- Pulse ox is down to 83 on 15 liters.
- What does that mean? That means she's not getting enough oxygen.
Come with me, Adam.
You're fine.
I just need room to work on your sister.
- Etomidate, atropine and sux.
- What is that? Medication to sedate her.
We may put a tube down her throat.
Abby, wait! - We don't want to infect Pratt's patient.
- We need a pediatric intubation tray.
All right.
I'll go around.
Keep her on 100 percent non-rebreather.
- We're gonna need another room.
- And a decontamination area.
- You gotta clear out.
- Could have a pulmonary contusion.
- What's his PO-2? - I can't get an ABG down to the lab.
It's a mucous plug.
He just needs suction.
Then a vent, Neurosurg consult, a burr hole.
I got an airborne deadly virus in there.
- What are you doing? - Moving him.
- He could crash in the hall.
- Smallpox could get him.
Little girl needs an airway.
I need this room.
Why don't you calm down? We don't know if it's smallpox.
Bag him.
Let's go.
- I need to get by.
- You can't.
- I work here.
- ER's been locked down.
Move back.
- Why? - Just trying to secure the building.
I'm the Chief of Emergency Medicine.
I need to get in there.
- I said, step back! - Dr.
Weaver? - What's going on? - They wouldn't let us back down.
Hi, it's Kerry Weaver.
Get Dr.
Romano.
No, don't you dare put me on hold! - I heard it's something contagious.
- Like what? - Excuse me, are you in charge? - No, find him.
- They brought my fiancé here.
- They're not letting anyone in.
- Yes, it's an emergency.
- He got into a bad accident.
Marta Guzman, 18, GSW to the right chest.
Last BP, 80 palp.
- They shut down the ER.
- Nobody radioed us.
I've got a GSW.
- My fiancé may be dying.
- You cannot go inside.
- Take her to Mercy? - Not with her pressure dropping.
- No breath sounds on the right.
Let us in.
- Not this entrance.
Not this floor.
She is bleeding into her chest.
How long do you think we'll be stuck in here? I don't know.
Maybe a day or two.
Might have to spend the night together.
You afraid? Of catching smallpox or waking up next to you? Okay, looking good.
- No retractions.
- He likes having his own room.
- You like having a little sister? - I bet you two never fight, do you? - I didn't think so.
- The alarm's going off! - Sinus brady at 45.
- Push.
4 of atropine.
Kids can drop their heart rate when oxygen gets low.
- I thought you fixed that.
- Lost the pulse.
- V-fib.
Starting compressions.
Get Lewis.
- Oh, God! - Hey, Pratt! Pratt! Get in here! - Hurry up! - Help her, please! - Want me to start bagging? - No.
Charge the paddles to 50.
- What's up? - Vascular clamp.
-0-silk's ready.
- My children.
They need me.
- Yes, they do, Marta.
So hold on.
All right, tube's in.
Needle driver.
- My kids.
- Somebody say "Thora-Seal"? - Right here! - Be careful.
You break it, you buy it.
- How about some Vaseline gauze? - How about a 2-ton safe? - Robert, I need to get her to Surgery.
- Tell me something I don't know.
Security's holding the freight elevator.
Meet there.
-500 cc's out so far.
- Pressure's up to 100.
Why has the Public Health Department closed the ER? I have no idea.
Elastoplast now.
Is there a communicable disease in the ER? - Usually is.
Pressure bags on both liters.
- Are you in touch with anyone inside? - Yes, I am.
- Who the hell is that? - Chief of Emergency Medicine.
- How many infected? We don't know that anyone is infected with anything.
- What disease can close a hospital? - Don't say it, Kerry.
- Maybe Ebola virus, anthrax? - I told you, I don't know.
Set the chest tube on water seal.
Are you aware that the Smallpox Response Team has been dispatched from the CDC? - Why didn't you tell us? - We' re sitting ducks! Clear.
- Still fib.
-5 minutes since the last epi.
- Another.
2.
- Why isn't it working? Charging to 80.
And clear! - No change.
- Let's try procainamide.
- You wanna give that to kids? -200 at 20 per minute.
- She's lighter than that.
- Know what you're doing? - We're following protocol.
- Charging to 90.
Clear.
- Call someone! - Still fib.
- I want someone more experienced! - There's no one! - Well, call them now! - Nobody's seen this disease for 50 years.
- Clear.
- Why aren't you telling us anything? - We don't even know if it's smallpox! - Give us masks! - You've already been exposed.
- To what? - We don't know, but we can help.
- By letting us go! I gotta get out of here.
We can't do that.
We won't do that.
We need time.
Listen! Listen! The exits are surrounded by the Chicago Police Department! - The police? - If you leave, you will be arrested! - We've been prisoners for four hours! - You will be arrested! - You better come check on Carter.
- Please return to your seats.
Please, I have to go home! I don't want my baby getting sick! - Clear.
- Fine V-fib.
- Could be a loose wire.
- It's not the leads, Pratt.
- Charging again to 100.
- Maybe it's not shocking her right.
Everything's working fine.
Clear.
- Asystole.
- Damn it! She could be hypovolemic.
Check for a pulse with compressions.
If you can't feel a pulse, she needs a fluid bolus.
- That's not the problem.
- Well, maybe it'll help! Good pulse with CPR.
She doesn't need fluids.
How long has it been? - Forty minutes.
- How about high-dose epi? - We've done everything.
- Could be worth a shot.
- That's it.
- What are you doing? You have to keep going! He had an idea! You have to keep going! Help her! Tell the CDC we have our first casualty.
- What are you doing? - I thought I was helping.
You're not.
When I call a code, that's it.
No discussion.
You overlooked high-dose epi.
Especially when the mother is sitting there.
- It was worth a shot! - Well, you were wrong.
- Well, now we'll never know.
- Do you ever listen? - Do you? - High-dose epi does not result in return of spontaneous circulation, or increased survival.
If you read the literature, you would know! Or you could teach me.
I don't have time to stop and explain things to you.
- I'm supposed to read your mind? - No.
Shut up and follow my lead! - Then lead! - Excuse me.
The Health Department wants us to double-shroud her.
- I'll do it.
- You're not going back in there.
- The mother still has questions.
- I'll take care of it.
- She trusts me.
- I said, no.
- You feel hot.
- What? - Abby, can you take his temperature? - It's 100 degrees in here.
- You feel hotter than that to me.
- I feel fine.
You have a fever.
- You always have to be right.
- And you have to be quarantined.
- You've been here for five hours? - Six.
Six! That's outrageous.
I'll be with you in just a moment.
- Where are you going with these? - We can't blow germs around.
Forget smallpox.
We'll have 100 starvation deaths if we don't get food.
You've got 20 minutes, then I'm ordering out pizza.
What's the name of that Public Health guy? David Torres.
- Your first name? - Why? Class-action lawsuit.
False imprisonment, intentional infliction of emotional distress.
Public Health has the authority- Malik, who is that? - What? - That voice.
- Jerry? - Vaccination of contacts can avert a widespread epidemic.
We refer to this strategy as "surveillance and containment.
" I want to assure the public that there is no need for panic.
And that only those in close contact with the infected individuals need the vaccine.
What? I was just calling my mom.
I love you too, Mom.
Brian Meadows is on the scene talking with two nurses who are unable to report for duty because- - Do you have to cover her face? - Yes, I ' m sorry.
- Do you want to take a minute? - Yeah.
- Mr.
Turner? - My wife didn't wanna go.
- We don't know how the kids got sick.
- No, it's my fault.
- Punch biopsy is next.
- Okay.
Private jet will take the samples to Atlanta for EM and PCR.
How's your breathing? - Dad? - Yeah? Was she scared? - What? - Bree.
When it happened.
She was asleep.
- Am I next? - No.
You promise? I promise.
- I have been ringing for 10 minutes! - Hell, I had to ring for an hour.
What do you need? Have to use the bathroom? Yes! Not that it's any of your business.
- How bad is it? - Really, really bad.
What are you doing? What's the point? If they bring an N95 mask and a gown - I can at least use the ladies' room.
- Don't hold your breath.
It's not my breath I'm worried about holding.
Here, you wanna use mine? - Her Dilantin level was eight? - Lab even re-checked it.
It's a water fountain, not a birdbath.
Doctor, I can't take my Naprosyn on an empty stomach.
- We may have some crackers.
- Crackers? You got crackers? Hey, eighter from Decatur! Boxcars? Oh, man! Play somewhere else.
I need to talk to Marge.
- But she's our lady luck.
- It's important.
Party pooper.
"What's up, doc? " I bet you hear that all the time.
How'd you get a commercial driver's license? - You have epilepsy, Marge.
- Just an occasional tic.
- I haven't had a seizure in years.
- Where'd you get your Dilantin? Mexico? The Internet? - You gonna tell the insurance company? - You had a seizure while driving.
- Could have killed everyone on the bus.
- You said they were okay.
Come here.
That's the guy you hit.
Does he look okay? What's wrong with him? - Luka! - I'll be back.
- Pressure's 60.
- Where's he bleeding? The pelvic fracture.
I should re-scan the belly.
- Looks like the IV's infiltrated.
- Yeah, throw in a central line.
- Be ready to transfuse two units.
- Yeah, if we could get to the blood bank.
- I hear you had crackers.
- Haven't seen any.
Are people lying to me? I will kick someone's ass if I don't get to eat! Don't come in here! - Etomidate's on board.
- Sixty of sux.
- You're gonna go to sleep now, Adam.
- Not like with Bree.
Just a little while.
- Your mom and dad will be right here.
- Adam? He's out.
Give me crichoid pressure, some suction.
Oh, God.
His upper airway is covered in lesions.
- Can you see the cords? - No, I won't be able to pass that tube.
- Bag him.
- Oh, no.
- You have to crike him? - I can't.
If I cut through the pox, it'll seed his lungs and make him worse.
- No free fluid.
It's a pelvic hematoma.
- Systolic's only 50.
- I get a flash, but I can't thread.
- I'm gonna go get a cutdown tray.
- Lost the carotid.
- Start compressions.
Carter's patient's in trouble.
We need a surgical airway.
- This guy's bleeding out.
- What should I say? T o do the best he can, okay? We need to open the lower neck to avoid the lesions.
A surgeon will come and do a formal tracheostomy.
- Then he'll be better? - Definitely.
- Luka's patient's in arrest.
- Get Romano.
- I don't think they're letting any- - Just get him.
- Dr.
Carter for you.
- How are things in the leper colony? - You're on with Romano.
- Hello? You called me.
The kid needs a trach.
I'd like to bring him upstairs.
- Forget it.
You'll infect the entire hospital.
- Why don't you come down? - That's easier said than done.
- Look, I need some help.
I'll see what I can work out.
Under the circumstances, you may be on your own.
- Just get your ass down here.
- Sats are dropping.
- Prep the neck.
- You sure? - Yeah, sure.
- You said a surgeon has to do this.
- Yeah, I started out in Surgery.
- What does that mean? - It means Dr.
Carter can do this.
- Give me a 10 blade.
- Form a single-file line.
- I need it for my blood sugar! - Damn it, people! We are not animals! - And we are not children either! - Dr.
Lewis! - Not now, Jerry.
- It stinks! Can we open a window? - No! - Bitch! - They didn't bring any diet soda.
We're doing the best we can.
A little sugar is not gonna kill you.
Thyroid isthmus is huge.
Suction.
Come on, suction! - I'm trying.
- God, there's so much blood! All right, hemostat.
- Bradying down.
- I can't even see the tracheal rings.
Another Kelly, 4x4s, and keep suctioning.
Okay.
- Mr.
Turner, squeeze this bag.
- No.
No.
Put your hand here, keep the mask secured and squeeze every three seconds.
One, two, three, bag.
One, two, three, bag.
He's dropping his pressure.
Spike another liter? No.
Keep this field clean so I can see what I'm doing.
4x4s.
- They're not answering the phone.
- Things are hectic.
- Is he still okay? - As soon as I get in, I'll check on him.
- Dr.
Lutz- - No statements at this time.
No comments.
I have no statement at this time.
No comments.
Kerry Weaver.
I chair the hospital's Bioterrorism Committee - and I'm Chief of the ER.
- Why aren't you inside? - I wasn't here.
- At least you weren't exposed.
- I would like to be able to assist.
- Only necessary personnel at this point.
- This is my ER.
- Not anymore.
Sorry, doctor.
Tracheal hook.
Retract cephalad.
- Short run of V-tach.
Lidocaine? - No, he needs oxygen.
11 blade.
Got it.
Bag faster.
All right.
Number four Shiley.
Pressure's 70.
Sats are down to 81.
- It won't go.
- What about a heliox? - I can't pass the tube.
- Help him, please.
Help him! - Maybe I have to switch the tank.
- Do it, do it, do it.
I'll try a cruciate incision.
- You know what? Pull off my mask! - What? Pull off my goggles, my mask.
I can't see.
I can't breathe.
Just do it! I don't care! Multifocal PVCs.
Come on, Adam! - Lost the pulse.
Starting CPR.
- Please.
Please.
There.
There, there, there.
Heart rate's up to 40.
Sats are coming up.
Strong carotid.
- Is he okay? - Yeah.
Thank you.
Somalia was the site of the last naturally acquired case of smallpox in 1977.
- It's a pox.
I know it.
- It's a cold sore.
And I don't wanna think about how you got it.
What are you doing? That is completely illegal.
- "Necessity has no laws.
" - Hey, hey.
Come on.
Get your hands off! - Now, you are just peeing in there, right? - Oh, shut up! I'm getting thirsty.
Water's the best I can do for you, bro.
- Does this help? - No.
Got a shy bladder, huh? Thanks.
- Why aren't you guys talking? - We don't have a lot in common.
- Stan? You feel like singing? - Yeah.
I'm not in the mood.
- His oxygen level's up to 95.
- So he's better? For now.
The lesions are on the inside too.
There's still the risk of organ failure.
But you can prevent that? We'll have to watch him very closely.
How are you holding up? - Oh, I don't know.
- How about your husband? You'd have to ask him.
Good news is, it's not the hemorrhagic form, which is 98 percent fatal.
That's a relief.
Do you think it would have made a difference? What? If I'd gotten to them sooner? Probably not.
Abby, Dr.
Lewis needs you.
Really nice save, Carter.
- Know what she wants? - Setting up the vaccine clinic.
- What does that have to do with me? - I guess you're doing it.
We need Ativan! He needs a drink.
He's having an alcohol withdrawal seizure.
Like I said, he needs a drink.
- Okay, I'm in.
- Dr.
Chen, 4 of Ativan.
- Throw it.
- Get sux and etomidate.
- Benzo's on board.
- I'm gonna bag him.
- Pulse is weak and thready.
- He's cyanotic.
Stan, damn it! You're not dying in here, you hear me? Stan! - Guess he heard you.
Sats are up.
- He's gonna need some Librium.
Not for hours.
That was exhausting.
Oh, yeah.
Prick the skin 15 times as shown here.
This should be done rapidly in a perpendicular fashion within a 5 mm diameter area.
- You have enough room in here? - If we clear this bed out, we'll be fine.
- We took a vote.
- Excuse me? If we get the shot, we won't get sick.
We' re ready.
- Yeah, unfortunately, that's not my call.
- Fine.
Right here.
Let's go.
- We haven't started.
- You'll get it.
- When? - After we get confirmation.
We're hot and starving to death.
You haven't done a thing! - We are running the tests right now.
- Let us leave.
Call us when you know.
- Move back and give us some room.
- Listen, jack-off! You move back! Okay, wait.
I know you're frustrated.
I know you're upset.
- Forget it.
I'm not waiting anymore.
- We have to do things this way.
- Stop stalling! - You had your chance! - Forget the tests! - Please, just relax.
Okay? It's gonna be all right.
Just relax.
Please.
- We can use this! - Let's go! Come on! Move, move! Slow down, guys.
Slow down! Hey, slow down! One, two, three! - Guys, you don't wanna- - Move! One, two, three! - Keep going.
- One, two, three! Hey! - What is going on out there? - I don't know.
- Where's Abby? - I don't know.
- Why aren't we doing anything? - I tried.
- Something bad's happened.
- No answer? - Phone's dead.
- Go across the street.
- What happened? Why? - Expanding the perimeter.
- Just a precaution.
- I need to speak to your supervisor.
If I were you, I would go home and be glad I didn't come to work today.
This morning, a 5-year-old girl came in with a rash that looked like smallpox.
She died quickly.
Her older brother is still critical.
We don't know what it is, and we don't know how they got it.
But it's here and it needs to be contained.
This is not about denying your civil rights.
This is about protecting you.
If we let you go, you could carry the disease home to your own families.
So please stay here.
Help us.
And we'll all get through this.
Yeah, okay, good.
- Let's talk in two hours.
- What? Electron microscopy shows a brick-shaped virus.
- An orthopox? - Right.
- So it is smallpox.
- Not necessarily.
- They're still running the PCR.
- How much longer? Make yourselves comfortable.
Look at the bright side: Only two critical patients and we're closed for paramedics.
- So, what now? - Well, we can watch ourselves on TV.
So far, the only suspected cases of smallpox are at County General in Chicago.
-50 cc's of urine output in the last hour.
- Well, I guess that's something.
- His kidneys are working.
- I cannot wait to leave.
- I'm gonna take a two-hour shower.
- I'm gonna sleep for 24 hours.
- How is he? - He's stable.
We know it's some form of orthopox, so we need to limit contact.
- Haven't we been doing that? - You've been doing a great job.
- The department would like to thank you.
- You're welcome.
Unfortunately, the two of you are gonna have to remain in this quarantine area.
- Why? We're not infectious.
- Just a precaution.
Why don't you just follow protocol and give us the vaccine? As soon as we get final confirmation on what we're dealing with.
- It's smallpox.
- The U.
S.
hasn't seen this since 1949.
Due to the unknown origin of this outbreak, we're being extra cautious.
Won't be much longer.
Thanks, guys.
Oh, man.
How much does this suck? "The department would like to thank you, but we can't bring you a fan.
" Is it me? It's like a sauna in here.
I'm soaked.
- Do you have a fever? - No! - Sit down.
- I'm fine.
Sit down.
- Take your temperature.
- I'm not infectious.
Stick the thermometer in your ear.
Today started out like a normal day, huh? - See, 99.
I told you.
- Okay.
You're still hot.
Is that better? Worst of this is over, right? Tell me we're gonna be okay.
We're gonna be okay.
We're gonna be okay.
R.
Previously on E.
R.
Mark's gone.
That means you've been here longer than any other doctor.
People will look to you to step in and fill the void.
Are you guys insane? I need to cross-clamp the aorta with that big-ass clamp.
You don't know what it's called, you shouldn't use it.
You wanna stay here, you do what I tell you, when I tell you.
It's that simple.
- No, thank you.
- Come on.
There's a meeting at 1.
- Great.
Go.
I'll catch up.
- When's the last time you went? - What do you think? - What's it gonna hurt? - It'll kill my buzz for starters.
- Come on, one step at a time.
You went for you or because you promised me you would? I went for you.
E.
R.
8x22 "LOCKDOWN" - Why is the dog bite still here? - I don't know.
- Waiting on his IV Unasyn.
- Any particular reason? Nurses aren't back from ACLS class yet.
The sooner he gets his meds, the sooner he gets discharged.
- I've done my share of IVs at the VA.
- There's no "I" in "team," Pratt.
- People really say crap like that here? - No.
But they should.
Dr.
Weaver on line one with a mouthful of marbles.
- What happened to her? - Chipped her tooth in Barbados.
I told her not to open bottles with her teeth.
So, Pratt, you wanna check orthostatics in Exam 3? - Why are you asking him? - I don't know.
He's got a cute ass? - We're down three nurses.
- Hey, we can help.
- Point is, why should we? - Let's all pitch in.
Pratt, check vitals.
Gallant, why don't you start IVs.
And I'll discharge Martinez here.
- All this because a nurse tells us to.
- Abby is the Obi-Wan Kenobi of nurses.
- So, what does that make you? Yoda? - Learn from her, you will.
Might have to separate these two.
Burns to the soles of the feet from hot coals.
- Fire walkers? - Lawyers.
- Why walk on hot coals? - It was a bonding exercise.
- We' re partners at the same firm.
- If I could walk, I'd kick your ass! - Would have worked if she hadn't pushed! - My feet were burning! - Anybody smell smoke? - Yeah, kind of.
- Of course you do.
We were charbroiled.
- No, it's - It's coming from your cuff! - Oh, my God! I'm on fire! Flames! Oops.
- This is not a hotel, Stan.
- I got the chills.
My teeth are rattling.
- I don't get no rest behind a dumpster.
- I have the flu.
You don't see me in bed.
I'd like to.
What about that Hippo oath you guys took? Do some good, be nice.
- Ask Dr.
Pratt.
He's handling you today.
- Is this because I'm new? - No.
Because you're annoying.
- Sure could do with a rubdown.
- Who wants the first tetanus shot? - Me, so I can get away from this moron.
You have to come back for wound-check tomorrow.
- Rather have my feet amputated.
- You don't have to do it together.
- Showers? - Don't have to do that together either.
That's fine.
Just pat the burns dry with a clean towel.
Dirty water running down to the foot increases chance of infection.
- How about the bathtub? - How about keeping them dry? How about y'all kiss and make up? Multiple MVA, two minutes out.
Marge Satterfield, bus driver of a gamblers' special, 50 altered at the scene.
- How's her airway? - Wide open.
Pulse ox, 98.
BP, 110/80.
You were in an accident, ma'am.
Let's take her to Trauma 1.
- Busload of senior citizens.
- How many do we have? - I'll work up this blunt head injury.
- First one out triages.
- Could be a hematoma.
- Next one might be worse.
Colin Prentice, 21, driver.
Head-on collision with the bus.
- Was he restrained? - Not very well.
Two-inch scalp lac.
- Broke the steering wheel.
- He driving a Matchbox? Worse, a Gremlin.
We intubated for a GCS 2-2-3.
BP, 120/70.
Pulse, 96.
- Trauma 2, let's go.
- Not by yourself.
Get Dr.
Lewis to help.
- How's Marge doing? Our driver.
- We don't know.
Ralph Meyers, 73.
Obvious forearm fracture with deformity.
- You having chest or belly pain? - No.
How will I play the slots? - Just use your other arm.
- I got another one for you, doc.
- Facial lac? - Broken glass.
Lenore Fong.
Neuro's intact.
- How old is she? - Got me.
Doesn't speak English.
- What'd she say? - "Rude to ask her age.
" Take her to Curtain 2.
Get it out of her, Deb.
Good.
That might be it.
Or not.
- Did you call the nurses from ACLS class? - They're all on a break.
Get some clerks or something.
We're dying down here.
- Can we have our aftercare instructions? - I'll be right with you.
- Miss, my colostomy bag is leaking.
- Just a minute, okay? - My family has been here for a long time.
- We got hit with a big accident.
- Both of my kids are sick.
- Someone will see them.
Yeah, we were here first.
I hope my passengers are okay.
They're all so old.
- No hemotympanum, toes downgoing.
- She need the O.
R.
? Nothing surgical so far.
Marge, any pain here? Good breath sounds bilaterally.
No tracheal shift.
- I gotta go.
- Not until you get a vent.
- Call for a C-spine, chest and pelvis.
- I don't know the numbers.
- Look at the phone list.
- Systolic's down to 80.
- Run in two liters wide open.
- This really isn't my job.
- It is today.
Feels like a pelvic fracture.
- Hello, this is Dr.
Pratt at the ER- - Please hold.
- Draw blood for a CBC and chem panel.
- I'm on hold.
- Type and cross for four.
- Find some O-neg.
- Got the SonoSite.
Oh, good.
I need to rule out intra-abdominal bleed.
- Chem panel goes in red top or green top? - Abby, help.
- Excuse me? - Go see if Kovac needs you.
- I need to start a dopamine drip.
- T op-right drawer.
- How's it going? - Might get more criticals.
Everybody's got multiple medical problems.
Is this 400 and 250? - It's a premix.
- Where's the head? - It's not in here.
- Then where? - No fluid in Morrison's pouch.
- Sir, you can't be in here.
- But I gotta take a whiz.
- Come with me.
Hang a left.
Can you call my daughter? Everybody move to the admit area so I can assess all of your injuries.
- Wanna see my bruises? - Not now.
- It hurts when I walk.
- Hey, Gallant, deal with this.
Listen, everybody proceed to the north.
We'll get you all taken care of.
- Where the hell is north? - All right, got the pressors.
- I thought she was hypertensive.
- Probably vagalled with the blood draw.
You could check him for compartment syndrome.
Why not? Can you wiggle your fingers? Damn foreigners ought to just get their own bus! - What'd she say? - "I had a fever.
" - And then something about his mother.
- Probably set the driver off, that gibberish.
- Marge was twitching, she was so mad.
- Twitching? - Like a Holy Roller.
- Excuse me.
- Might have had a seizure.
- After the accident? Before.
She have a medical alert bracelet? Check her wallet.
Mental status is consistent with a post-ictal state.
- I've got a couple of really sick kids.
- I'm busy right now.
- Half-load of phenytoin, send off levels.
- They had fevers a week ago - then developed a rash.
- No myoclonus.
- Pretty bad.
Think you need to see them.
- Go, Carter.
We got this.
- Sir, ma'am, this is Dr.
Carter.
- Okay, let's take a look.
We thought it was chickenpox, but I've never seen it as bad as this.
- Can you lift up her shirt? - It's not on her chest or her stomach.
Adam doesn't have it as bad.
- When did the rash start? - Three days ago.
- How long have you been waiting? - Too long.
Tried to tell that nurse, but she said it was busy.
Could it be an allergic reaction? No.
Would you excuse me? Get masks on them.
- Hey, what's up? - Where are the tubes? - What? - Those tubes with the posters in them.
Oh, those Public Health things? They should be over there, man.
Oh, man.
What? What's going on? Michael, would you go get Dr.
Lewis? Now! I'm gonna move you to a private room.
Can you take Adam? Follow me quickly.
- What is it? - It's just a precaution.
Excuse me.
Coming through here.
Can you move out of the way? - Why are we running? - Just stay with me.
Right up here.
- All right, stay here.
I'll be right back.
- What is going on? - Where is she? - Getting a central-line kit.
Susan, just come with me.
- I think I got two cases of smallpox.
- Oh, my God.
Firm, deep-seated pustules, all in the same stage of development.
- Just a bad case of chickenpox.
- Centrifugal distribution sparing the trunk.
It's all the major criteria.
We haven't had a case here since the '40s.
It's airborne.
We need to lock this place down.
Okay.
Elevator lobby, north stairwell, south corridor are all secure.
- Security's locking the ambulance bay.
- Is that a fire safety violation? - We' re closed.
- Is Public Health on the way? Do I call the State Department? - Check the emergency response plan.
- This is the plan.
- I don't know.
Call all three.
- Hey, hold on.
- Think you're jumping to conclusions? - You seen smallpox before? No, that's my point.
It could be anything.
Scabies, pityriasis, chickenpox.
- This is not chickenpox.
- Are you 100 percent certain? - You wanna risk exposure to the city? - Whoa! How bad is it? - Killed half of Europe.
- They have a vaccine.
- The CDC should have a stockpile.
- In Chicago? - Atlanta.
- Oh, great.
Luka's right.
Smallpox has been eradicated.
I heard the Russians had some on ice.
- If a terrorist group- - Shut up, Jerry.
Damn, I should have called in sick today.
- What? - Lock it down.
They're on their way.
- The entire hospital? - The ER.
- What do we do about critical patients? - You're asking me? - They're brother and sister.
- Yeah.
- Five and 10? - Yeah, why? I think I treated them last Tuesday.
They presented with the flu.
I have a fever.
- You need to be quarantined.
- Hey, slow down, guys.
Susan, you gotta come up with a plan now.
Okay, okay.
Deb, Carter's right.
You're quarantined to Exam 4.
Jerry, pull the staff schedule and patient log from last Tuesday.
Luka, re-assess all the patients, group the criticals.
- I'll take care of Public Health.
- What about the kids? Nobody panics.
Nobody starts any rumors.
This is just routine.
Then you better tell them why the doors are locked.
Carter, wait.
Do you know that family sat in Chairs for 45 minutes? - Should have been isolated.
- They would, had I seen them.
- Pretty hard to miss.
- We're down three nurses.
I told you.
- What are you doing? - If it's smallpox, it could get septic.
- Hope I'm not right.
- You'll need help.
Don't come if you're worried about exposure.
I've already been exposed.
Who's in charge? I got a cop telling me I can't go.
- Why are you detaining us? - I'm about to explain.
- If I don't get a cigarette, I'll go postal.
- Ma'am, please! - Okay, Jerry.
Does this thing still work? - It did in '95.
- What the hell is going on, huh? - Does this place even have a license? Sorry.
I'm Dr.
Lewis.
As you may have noticed there are guards posted at all the exits.
This is because we have a potential public health concern.
I would like to emphasize the word "potential.
" Because at present, we don't have any conclusive evidence.
City authorities are on their way to assist.
However, until we have more information we ask that no one enter or leave the department.
- What do you mean we can't leave? - This is purely a precaution.
When I know more, you'll know more.
Thank you for your patience.
- I want out of here! I'm getting out! - My wife is expecting me! Don't you understand? What kind of authorities are you talking about? - That helping? - Do I look like her? - Not as bad.
- Was anybody sick around you? - I don't think so.
- We were at the embassies, hotels.
- We stood out.
- Where? Central Africa.
Craig works for the State Department.
- When did you get back? - Two weeks ago.
Okay.
Okay, we need to keep you both in isolation.
- Why? - You could be incubating the virus.
- You probably both are.
- You said 10 to 14 days.
We need to know where you've been, who you've been with since your kids developed a fever.
- The kids were in school.
- They could get sicker? We need skin biopsies and smears to send to the CDC biocontainment lab.
- They could die? - We're being careful.
Nothing's confirmed.
Dr.
Carter.
Is she tachycardiac? I don't know, but you're freaking them out.
Slow down.
Hey, you okay? Biggest public health emergency of the century, and I'm stuck here.
Stuck? This is the damn Ritz if you ask me.
Sorry.
You got a roommate.
Oh, come on! Were you really here last Tuesday, Stan? Yeah, sure I was.
You know, they say this could be very serious.
I've had gastritis, hepatitis, pancreatitis.
A little pox is not gonna bother me.
- You got a temperature too? - Probably just a flu.
It's not smallpox.
It can't be.
It's just gotta be a mistake.
- County.
- How in the hell long is it gonna be? - Sir, I don't know.
- Will you pay for the hours I miss? - Gallant, how are the seniors? - Mostly sprains and contusions.
Thank God for small favors.
What about Public Health? En route.
But Chicago P.
D.
is here, with billy clubs and handcuffs.
Gee, I feel safe now.
Where do you think you're going? She needs a head CT.
She's not infectious.
Does she have a blown pupil? - No.
- Then she can wait.
- She's an older trauma patient.
- Do you know where you are? - Looks like a hospital.
A crappy one.
- I'd say she's pretty lucid.
Dr.
Lewis.
David Torres, Public Health.
We can take over now.
- The crisis or the patient care? - This is for contact tracing.
- And this is for you.
- Okay.
The CDC will be flying in from Atlanta.
We need this area for our staff.
Dr.
Torres, I'm down in Engineering.
First and second floor share ventilation.
- Kill the a.
c.
- It's 80 degrees outside.
Welcome to the hot zone.
May I see the infected kids, please? No, the infection's in the bloodstream, which makes the lungs leak fluid.
- But she's been responding to oxygen.
- We never should have been there! You could have stayed home.
And your children don't see you for a year! If there was an outbreak, we'd have heard.
Craig, we were targets.
A maniac is using this as a weapon.
- There are a lot of unknowns.
- There's something wrong with Bree.
- Pulse ox is down to 83 on 15 liters.
- What does that mean? That means she's not getting enough oxygen.
Come with me, Adam.
You're fine.
I just need room to work on your sister.
- Etomidate, atropine and sux.
- What is that? Medication to sedate her.
We may put a tube down her throat.
Abby, wait! - We don't want to infect Pratt's patient.
- We need a pediatric intubation tray.
All right.
I'll go around.
Keep her on 100 percent non-rebreather.
- We're gonna need another room.
- And a decontamination area.
- You gotta clear out.
- Could have a pulmonary contusion.
- What's his PO-2? - I can't get an ABG down to the lab.
It's a mucous plug.
He just needs suction.
Then a vent, Neurosurg consult, a burr hole.
I got an airborne deadly virus in there.
- What are you doing? - Moving him.
- He could crash in the hall.
- Smallpox could get him.
Little girl needs an airway.
I need this room.
Why don't you calm down? We don't know if it's smallpox.
Bag him.
Let's go.
- I need to get by.
- You can't.
- I work here.
- ER's been locked down.
Move back.
- Why? - Just trying to secure the building.
I'm the Chief of Emergency Medicine.
I need to get in there.
- I said, step back! - Dr.
Weaver? - What's going on? - They wouldn't let us back down.
Hi, it's Kerry Weaver.
Get Dr.
Romano.
No, don't you dare put me on hold! - I heard it's something contagious.
- Like what? - Excuse me, are you in charge? - No, find him.
- They brought my fiancé here.
- They're not letting anyone in.
- Yes, it's an emergency.
- He got into a bad accident.
Marta Guzman, 18, GSW to the right chest.
Last BP, 80 palp.
- They shut down the ER.
- Nobody radioed us.
I've got a GSW.
- My fiancé may be dying.
- You cannot go inside.
- Take her to Mercy? - Not with her pressure dropping.
- No breath sounds on the right.
Let us in.
- Not this entrance.
Not this floor.
She is bleeding into her chest.
How long do you think we'll be stuck in here? I don't know.
Maybe a day or two.
Might have to spend the night together.
You afraid? Of catching smallpox or waking up next to you? Okay, looking good.
- No retractions.
- He likes having his own room.
- You like having a little sister? - I bet you two never fight, do you? - I didn't think so.
- The alarm's going off! - Sinus brady at 45.
- Push.
4 of atropine.
Kids can drop their heart rate when oxygen gets low.
- I thought you fixed that.
- Lost the pulse.
- V-fib.
Starting compressions.
Get Lewis.
- Oh, God! - Hey, Pratt! Pratt! Get in here! - Hurry up! - Help her, please! - Want me to start bagging? - No.
Charge the paddles to 50.
- What's up? - Vascular clamp.
-0-silk's ready.
- My children.
They need me.
- Yes, they do, Marta.
So hold on.
All right, tube's in.
Needle driver.
- My kids.
- Somebody say "Thora-Seal"? - Right here! - Be careful.
You break it, you buy it.
- How about some Vaseline gauze? - How about a 2-ton safe? - Robert, I need to get her to Surgery.
- Tell me something I don't know.
Security's holding the freight elevator.
Meet there.
-500 cc's out so far.
- Pressure's up to 100.
Why has the Public Health Department closed the ER? I have no idea.
Elastoplast now.
Is there a communicable disease in the ER? - Usually is.
Pressure bags on both liters.
- Are you in touch with anyone inside? - Yes, I am.
- Who the hell is that? - Chief of Emergency Medicine.
- How many infected? We don't know that anyone is infected with anything.
- What disease can close a hospital? - Don't say it, Kerry.
- Maybe Ebola virus, anthrax? - I told you, I don't know.
Set the chest tube on water seal.
Are you aware that the Smallpox Response Team has been dispatched from the CDC? - Why didn't you tell us? - We' re sitting ducks! Clear.
- Still fib.
-5 minutes since the last epi.
- Another.
2.
- Why isn't it working? Charging to 80.
And clear! - No change.
- Let's try procainamide.
- You wanna give that to kids? -200 at 20 per minute.
- She's lighter than that.
- Know what you're doing? - We're following protocol.
- Charging to 90.
Clear.
- Call someone! - Still fib.
- I want someone more experienced! - There's no one! - Well, call them now! - Nobody's seen this disease for 50 years.
- Clear.
- Why aren't you telling us anything? - We don't even know if it's smallpox! - Give us masks! - You've already been exposed.
- To what? - We don't know, but we can help.
- By letting us go! I gotta get out of here.
We can't do that.
We won't do that.
We need time.
Listen! Listen! The exits are surrounded by the Chicago Police Department! - The police? - If you leave, you will be arrested! - We've been prisoners for four hours! - You will be arrested! - You better come check on Carter.
- Please return to your seats.
Please, I have to go home! I don't want my baby getting sick! - Clear.
- Fine V-fib.
- Could be a loose wire.
- It's not the leads, Pratt.
- Charging again to 100.
- Maybe it's not shocking her right.
Everything's working fine.
Clear.
- Asystole.
- Damn it! She could be hypovolemic.
Check for a pulse with compressions.
If you can't feel a pulse, she needs a fluid bolus.
- That's not the problem.
- Well, maybe it'll help! Good pulse with CPR.
She doesn't need fluids.
How long has it been? - Forty minutes.
- How about high-dose epi? - We've done everything.
- Could be worth a shot.
- That's it.
- What are you doing? You have to keep going! He had an idea! You have to keep going! Help her! Tell the CDC we have our first casualty.
- What are you doing? - I thought I was helping.
You're not.
When I call a code, that's it.
No discussion.
You overlooked high-dose epi.
Especially when the mother is sitting there.
- It was worth a shot! - Well, you were wrong.
- Well, now we'll never know.
- Do you ever listen? - Do you? - High-dose epi does not result in return of spontaneous circulation, or increased survival.
If you read the literature, you would know! Or you could teach me.
I don't have time to stop and explain things to you.
- I'm supposed to read your mind? - No.
Shut up and follow my lead! - Then lead! - Excuse me.
The Health Department wants us to double-shroud her.
- I'll do it.
- You're not going back in there.
- The mother still has questions.
- I'll take care of it.
- She trusts me.
- I said, no.
- You feel hot.
- What? - Abby, can you take his temperature? - It's 100 degrees in here.
- You feel hotter than that to me.
- I feel fine.
You have a fever.
- You always have to be right.
- And you have to be quarantined.
- You've been here for five hours? - Six.
Six! That's outrageous.
I'll be with you in just a moment.
- Where are you going with these? - We can't blow germs around.
Forget smallpox.
We'll have 100 starvation deaths if we don't get food.
You've got 20 minutes, then I'm ordering out pizza.
What's the name of that Public Health guy? David Torres.
- Your first name? - Why? Class-action lawsuit.
False imprisonment, intentional infliction of emotional distress.
Public Health has the authority- Malik, who is that? - What? - That voice.
- Jerry? - Vaccination of contacts can avert a widespread epidemic.
We refer to this strategy as "surveillance and containment.
" I want to assure the public that there is no need for panic.
And that only those in close contact with the infected individuals need the vaccine.
What? I was just calling my mom.
I love you too, Mom.
Brian Meadows is on the scene talking with two nurses who are unable to report for duty because- - Do you have to cover her face? - Yes, I ' m sorry.
- Do you want to take a minute? - Yeah.
- Mr.
Turner? - My wife didn't wanna go.
- We don't know how the kids got sick.
- No, it's my fault.
- Punch biopsy is next.
- Okay.
Private jet will take the samples to Atlanta for EM and PCR.
How's your breathing? - Dad? - Yeah? Was she scared? - What? - Bree.
When it happened.
She was asleep.
- Am I next? - No.
You promise? I promise.
- I have been ringing for 10 minutes! - Hell, I had to ring for an hour.
What do you need? Have to use the bathroom? Yes! Not that it's any of your business.
- How bad is it? - Really, really bad.
What are you doing? What's the point? If they bring an N95 mask and a gown - I can at least use the ladies' room.
- Don't hold your breath.
It's not my breath I'm worried about holding.
Here, you wanna use mine? - Her Dilantin level was eight? - Lab even re-checked it.
It's a water fountain, not a birdbath.
Doctor, I can't take my Naprosyn on an empty stomach.
- We may have some crackers.
- Crackers? You got crackers? Hey, eighter from Decatur! Boxcars? Oh, man! Play somewhere else.
I need to talk to Marge.
- But she's our lady luck.
- It's important.
Party pooper.
"What's up, doc? " I bet you hear that all the time.
How'd you get a commercial driver's license? - You have epilepsy, Marge.
- Just an occasional tic.
- I haven't had a seizure in years.
- Where'd you get your Dilantin? Mexico? The Internet? - You gonna tell the insurance company? - You had a seizure while driving.
- Could have killed everyone on the bus.
- You said they were okay.
Come here.
That's the guy you hit.
Does he look okay? What's wrong with him? - Luka! - I'll be back.
- Pressure's 60.
- Where's he bleeding? The pelvic fracture.
I should re-scan the belly.
- Looks like the IV's infiltrated.
- Yeah, throw in a central line.
- Be ready to transfuse two units.
- Yeah, if we could get to the blood bank.
- I hear you had crackers.
- Haven't seen any.
Are people lying to me? I will kick someone's ass if I don't get to eat! Don't come in here! - Etomidate's on board.
- Sixty of sux.
- You're gonna go to sleep now, Adam.
- Not like with Bree.
Just a little while.
- Your mom and dad will be right here.
- Adam? He's out.
Give me crichoid pressure, some suction.
Oh, God.
His upper airway is covered in lesions.
- Can you see the cords? - No, I won't be able to pass that tube.
- Bag him.
- Oh, no.
- You have to crike him? - I can't.
If I cut through the pox, it'll seed his lungs and make him worse.
- No free fluid.
It's a pelvic hematoma.
- Systolic's only 50.
- I get a flash, but I can't thread.
- I'm gonna go get a cutdown tray.
- Lost the carotid.
- Start compressions.
Carter's patient's in trouble.
We need a surgical airway.
- This guy's bleeding out.
- What should I say? T o do the best he can, okay? We need to open the lower neck to avoid the lesions.
A surgeon will come and do a formal tracheostomy.
- Then he'll be better? - Definitely.
- Luka's patient's in arrest.
- Get Romano.
- I don't think they're letting any- - Just get him.
- Dr.
Carter for you.
- How are things in the leper colony? - You're on with Romano.
- Hello? You called me.
The kid needs a trach.
I'd like to bring him upstairs.
- Forget it.
You'll infect the entire hospital.
- Why don't you come down? - That's easier said than done.
- Look, I need some help.
I'll see what I can work out.
Under the circumstances, you may be on your own.
- Just get your ass down here.
- Sats are dropping.
- Prep the neck.
- You sure? - Yeah, sure.
- You said a surgeon has to do this.
- Yeah, I started out in Surgery.
- What does that mean? - It means Dr.
Carter can do this.
- Give me a 10 blade.
- Form a single-file line.
- I need it for my blood sugar! - Damn it, people! We are not animals! - And we are not children either! - Dr.
Lewis! - Not now, Jerry.
- It stinks! Can we open a window? - No! - Bitch! - They didn't bring any diet soda.
We're doing the best we can.
A little sugar is not gonna kill you.
Thyroid isthmus is huge.
Suction.
Come on, suction! - I'm trying.
- God, there's so much blood! All right, hemostat.
- Bradying down.
- I can't even see the tracheal rings.
Another Kelly, 4x4s, and keep suctioning.
Okay.
- Mr.
Turner, squeeze this bag.
- No.
No.
Put your hand here, keep the mask secured and squeeze every three seconds.
One, two, three, bag.
One, two, three, bag.
He's dropping his pressure.
Spike another liter? No.
Keep this field clean so I can see what I'm doing.
4x4s.
- They're not answering the phone.
- Things are hectic.
- Is he still okay? - As soon as I get in, I'll check on him.
- Dr.
Lutz- - No statements at this time.
No comments.
I have no statement at this time.
No comments.
Kerry Weaver.
I chair the hospital's Bioterrorism Committee - and I'm Chief of the ER.
- Why aren't you inside? - I wasn't here.
- At least you weren't exposed.
- I would like to be able to assist.
- Only necessary personnel at this point.
- This is my ER.
- Not anymore.
Sorry, doctor.
Tracheal hook.
Retract cephalad.
- Short run of V-tach.
Lidocaine? - No, he needs oxygen.
11 blade.
Got it.
Bag faster.
All right.
Number four Shiley.
Pressure's 70.
Sats are down to 81.
- It won't go.
- What about a heliox? - I can't pass the tube.
- Help him, please.
Help him! - Maybe I have to switch the tank.
- Do it, do it, do it.
I'll try a cruciate incision.
- You know what? Pull off my mask! - What? Pull off my goggles, my mask.
I can't see.
I can't breathe.
Just do it! I don't care! Multifocal PVCs.
Come on, Adam! - Lost the pulse.
Starting CPR.
- Please.
Please.
There.
There, there, there.
Heart rate's up to 40.
Sats are coming up.
Strong carotid.
- Is he okay? - Yeah.
Thank you.
Somalia was the site of the last naturally acquired case of smallpox in 1977.
- It's a pox.
I know it.
- It's a cold sore.
And I don't wanna think about how you got it.
What are you doing? That is completely illegal.
- "Necessity has no laws.
" - Hey, hey.
Come on.
Get your hands off! - Now, you are just peeing in there, right? - Oh, shut up! I'm getting thirsty.
Water's the best I can do for you, bro.
- Does this help? - No.
Got a shy bladder, huh? Thanks.
- Why aren't you guys talking? - We don't have a lot in common.
- Stan? You feel like singing? - Yeah.
I'm not in the mood.
- His oxygen level's up to 95.
- So he's better? For now.
The lesions are on the inside too.
There's still the risk of organ failure.
But you can prevent that? We'll have to watch him very closely.
How are you holding up? - Oh, I don't know.
- How about your husband? You'd have to ask him.
Good news is, it's not the hemorrhagic form, which is 98 percent fatal.
That's a relief.
Do you think it would have made a difference? What? If I'd gotten to them sooner? Probably not.
Abby, Dr.
Lewis needs you.
Really nice save, Carter.
- Know what she wants? - Setting up the vaccine clinic.
- What does that have to do with me? - I guess you're doing it.
We need Ativan! He needs a drink.
He's having an alcohol withdrawal seizure.
Like I said, he needs a drink.
- Okay, I'm in.
- Dr.
Chen, 4 of Ativan.
- Throw it.
- Get sux and etomidate.
- Benzo's on board.
- I'm gonna bag him.
- Pulse is weak and thready.
- He's cyanotic.
Stan, damn it! You're not dying in here, you hear me? Stan! - Guess he heard you.
Sats are up.
- He's gonna need some Librium.
Not for hours.
That was exhausting.
Oh, yeah.
Prick the skin 15 times as shown here.
This should be done rapidly in a perpendicular fashion within a 5 mm diameter area.
- You have enough room in here? - If we clear this bed out, we'll be fine.
- We took a vote.
- Excuse me? If we get the shot, we won't get sick.
We' re ready.
- Yeah, unfortunately, that's not my call.
- Fine.
Right here.
Let's go.
- We haven't started.
- You'll get it.
- When? - After we get confirmation.
We're hot and starving to death.
You haven't done a thing! - We are running the tests right now.
- Let us leave.
Call us when you know.
- Move back and give us some room.
- Listen, jack-off! You move back! Okay, wait.
I know you're frustrated.
I know you're upset.
- Forget it.
I'm not waiting anymore.
- We have to do things this way.
- Stop stalling! - You had your chance! - Forget the tests! - Please, just relax.
Okay? It's gonna be all right.
Just relax.
Please.
- We can use this! - Let's go! Come on! Move, move! Slow down, guys.
Slow down! Hey, slow down! One, two, three! - Guys, you don't wanna- - Move! One, two, three! - Keep going.
- One, two, three! Hey! - What is going on out there? - I don't know.
- Where's Abby? - I don't know.
- Why aren't we doing anything? - I tried.
- Something bad's happened.
- No answer? - Phone's dead.
- Go across the street.
- What happened? Why? - Expanding the perimeter.
- Just a precaution.
- I need to speak to your supervisor.
If I were you, I would go home and be glad I didn't come to work today.
This morning, a 5-year-old girl came in with a rash that looked like smallpox.
She died quickly.
Her older brother is still critical.
We don't know what it is, and we don't know how they got it.
But it's here and it needs to be contained.
This is not about denying your civil rights.
This is about protecting you.
If we let you go, you could carry the disease home to your own families.
So please stay here.
Help us.
And we'll all get through this.
Yeah, okay, good.
- Let's talk in two hours.
- What? Electron microscopy shows a brick-shaped virus.
- An orthopox? - Right.
- So it is smallpox.
- Not necessarily.
- They're still running the PCR.
- How much longer? Make yourselves comfortable.
Look at the bright side: Only two critical patients and we're closed for paramedics.
- So, what now? - Well, we can watch ourselves on TV.
So far, the only suspected cases of smallpox are at County General in Chicago.
-50 cc's of urine output in the last hour.
- Well, I guess that's something.
- His kidneys are working.
- I cannot wait to leave.
- I'm gonna take a two-hour shower.
- I'm gonna sleep for 24 hours.
- How is he? - He's stable.
We know it's some form of orthopox, so we need to limit contact.
- Haven't we been doing that? - You've been doing a great job.
- The department would like to thank you.
- You're welcome.
Unfortunately, the two of you are gonna have to remain in this quarantine area.
- Why? We're not infectious.
- Just a precaution.
Why don't you just follow protocol and give us the vaccine? As soon as we get final confirmation on what we're dealing with.
- It's smallpox.
- The U.
S.
hasn't seen this since 1949.
Due to the unknown origin of this outbreak, we're being extra cautious.
Won't be much longer.
Thanks, guys.
Oh, man.
How much does this suck? "The department would like to thank you, but we can't bring you a fan.
" Is it me? It's like a sauna in here.
I'm soaked.
- Do you have a fever? - No! - Sit down.
- I'm fine.
Sit down.
- Take your temperature.
- I'm not infectious.
Stick the thermometer in your ear.
Today started out like a normal day, huh? - See, 99.
I told you.
- Okay.
You're still hot.
Is that better? Worst of this is over, right? Tell me we're gonna be okay.
We're gonna be okay.
We're gonna be okay.