ER s09e05 Episode Script

Previously on E.
R.
When you' re waiting on a patient's results it's not necessary for you to boff that patient's mother in the storage closet.
I'm so sorry, Robert.
What, about my arm or about not being there? - Memo from Weaver.
- What? I've made Abby the new nurse manager.
The job is yours, like it or not.
- Like it or not? - I don't care to argue about it.
Duroziez's sign is a murmur when the stethoscope is over the femoral artery.
What's another sign? - Weak pulse.
- No.
- Poor cap refill? - No.
Those are both signs of shock.
It begins with Q.
Anyone? - De Quervain's? - No.
That begins with a D.
However, there is a Q in it, so you' re getting warmer.
Does Quincke's sign ring any bells? And it manifests itself how? With a visible - Pulsation.
- Correct.
Where? On the - Neck.
- Navel? Nail bed.
Good night.
Go home.
Rounds start at 7 a.
m.
Be sure to read Sabiston's chapter on the acute abdomen.
So much for the future of medicine.
Jacy, be sure to ring Mr.
Ingles.
Remind him not to eat anything after midnight.
I don't want to have to reschedule his hernia yet again.
I'm going trick-or-treating.
- Oh, what's Ella this year? - A cow.
- Wasn't she a cow last year? - No, she was Dorothy.
I was the Cowardly Lion, and Mark- Mark was the Scarecrow.
Right.
I get to be a farmer this year.
Happy Halloween.
- Dr.
Corday.
- Yeah? Your med student called.
Nathan.
The one who didn't show up today? - He said he'd be here in a few minutes.
- Too late.
Dr.
Romano would like to talk with you before you leave.
- Tell him you couldn't find me.
- I heard that.
Check this guy out.
- What the hell are you supposed to be? - Want a candy, fellow? Put some meat on those bones.
- Hi.
I thought everyone was dressing up.
- We were supposed to.
There was a memo.
- I didn't bring anything to change into.
- Nor did I.
You' re still a nurse.
You should've called.
Then I would be the only one.
I don't think so.
- Frank, where's your costume? - I don't observe pagan holidays - that celebrate devil worship.
- Well, this is only for Satanists.
- What? Shut up.
- It's kind of working for you.
You give me an order I think is wrong I'm gonna ask you to clarify.
- Not in front of patients.
- I only questioned the dosage.
- You made mistakes in the past.
- I have not.
- Is there a problem? - Yeah, you got no guts.
- I'm not working with him.
- Why? - Because he treats nurses like idiots.
- If your boots fit - Shoes.
- Whatever.
You' re wearing that for your shift? Yes.
It's Halloween.
You know, Jerry sent out a memo.
- Oh, naughty nurse.
- I'm not a naughty nurse.
- I like it.
- No, I'm a- It's an old-fashioned nurse.
- Looks naughty to me.
- So you're what, like, a kurva nurse? - What's that? - How do you say? - A slut? You know, like a tramp, whore.
- Yeah, I got it.
You know, maybe I should've worn that schoolgirl outfit you bought me.
She's making a joke.
Cautery.
Robert, what are you doing? Laparoscopic cholecystectomy.
But you can't be.
I had no choice.
Poor swine's full of stones.
Oh, for heaven's sake.
It's a pig.
I hope you' re not expecting me to scrub in.
No, giving my hand a workout.
It's been five months.
I gotta keep my skills up.
Stapler.
Even with one arm I'm a better surgeon than the hacks in this hospital.
Robert, you' re not cleared to do surgery, even on barn animals.
Were you aware that Weaver put through a proposal to hire PAs to cover afternoon rounds for post-call surgical residents? Yes.
It was a very good idea.
Not the point.
The point is nobody talked to me about it.
Last time I checked, I was head of both surgery and this hospital.
The Residency Review Committee- Oh, sweet Mary and Joseph! Would you look at the size of that gallbladder.
Jeez, you could feed a small Amish family for a week with that thing.
I know Weaver's formed alliances with the tribal elders while I was recuperating.
- I expected more loyalty from you.
- Robert- Rewrite the proposal as if it came from us.
Keep me abreast of other covert Weaver ops.
Okay? The last thing I need is Mata Hari leading a palace coup.
- What the hell? - He's extubated.
Get him back under.
Hundred of Peridol.
Hold him down! Lizzie, hold him down! - Bloody hell.
- He's a pig.
Grab a loin, Lizzie! Flex.
Flex.
Keep going.
Ninety degrees.
That's good.
Not my elbow I'm worried about.
What's going on down there? Brenda! All right, the wrist.
Flex.
Keep going.
A little bit more.
- Ten degrees.
- Wrong.
Check it again.
Ten.
- It was 15 last week.
- Fluctuations are normal, Robert.
With this type of injury, you gotta give yourself at least nine months.
How does this affect my odds? - You've still got a long way to go.
- Yeah, I know.
The odds.
For full flexion, extension and opposition of the digits, 20 percent.
But even then, without radial and ulnar deviation of the thumb I'm not sure you'll be able to operate.
But you can still be Chief of Staff.
Most of your job's administrative anyway.
Thanks for the pep talk there, Marty.
Excuse me.
I'm looking for Dr.
Corday.
Yeah, aren't we all.
Are you a bill collector or a suitor? - Med student.
- Must be a slow learner.
- Career change.
- Cowboy and fireman didn't work? I'm supposed to start my surgical rotation.
I'm Paul Nathan.
Dr.
Romano.
- What happened? - Tennis elbow.
Fire at a Halloween party.
At least 30 victims.
Gave 10 of morphine IM.
- How you doing? - Not good.
- What's your name? - Amy.
- Last name? - There was fire at the party downstairs.
Your last name? - Anybody with her? - Hard to say.
The building's burning.
- A lot of confusion.
- Soot in nostrils, intra-oral burns.
I need an intubation tray.
Get Corday on the crushed pelvis.
- Excuse me.
- Not now.
Ed Jemena, 35.
Full-thickness burns to the hands and forearms.
Guy was on fire.
I tried to put him out.
I didn't have anything but my hands.
- Luka, can you get this? - Yeah.
- What's open? - Curtain 2.
- A trauma room.
- Lucky to get a bed.
- Okay, yes? - Oh, Paul Nathan.
- Radiology? - No.
Surgery.
- Resident? - Med student.
Good enough.
Cellulitis to the leg after a bug bite to the ankle.
- What do I do? - Mark the leading edge with a marker.
Nice catch.
Whoa, we' re full in here.
- What do you have? - Doctor, excuse me You all need to stay in your assigned spots.
If a doctor or nurse can't find you, it'll delay your treatment.
Doctor, doctor, can you tell me what's happened to my things? - My apartment's on the fourth floor.
- I'll see.
- The fire was on two.
- Will they let us go home? - Ask the fire department.
- How did it start? Was it a gas leak? - I'm sorry, I don't know.
- Carter, we need you.
- Fruits upstairs were smoking dope.
- No one was smoking anything, all right? - What's that for? - To keep an eye on the infection.
- What are they giving him to stop it? - Excuse me.
Unasyn.
- That'll get rid of the infection? - It should.
It's an antibiotic.
- Hey, you a doctor? - Med student.
I need that Mayo stand.
Put it under his arm.
- Got this? - I'm supposed to be- Good.
I need a cutdown tray.
What are you going to do? - We' re gonna make you better.
- Why can't I feel my hands? The burns have damaged your nerves.
Is it permanent? I don't know.
- Where's Terry? - Who's Terry? My partner.
He's dressed like a jungle girl.
- Etomidate's on board.
- I need to see Terry.
Trauma panel, carboxyhemoglobin, and ABG.
Prime a line of ringers.
- What is this? - Rubber mask melted to the face.
- I can barely open the mouth.
- Try fiberoptic.
I got the subclavian.
- I thought you left, Lizzie.
- Supposed to be trick-or-treating.
- Little old, don't you think? - Open a crike tray in case.
- Guide wire's passing well.
- Pre-load an 8-0 tube on a scope.
- Pulse ox down to 85.
- Fifteen blade.
Ten-cc syringe.
Let's check the balloon.
I need a different light source.
Don't open the tray unless the intubation fails.
Don't want- Sorry.
Sorry.
Got the line, run the first liter wide open.
Robert, you okay? -0-silk, Neosporin, and OpSite.
- Robert? I'm okay.
Keep bagging on 15 liters.
Get sats above 90.
If you got this, Lizzie, I'm gonna go check on the rest of the kids.
- Take slow deep breaths.
- I'm trying.
- Have you ever had asthma? - No.
- What's this? - Smoke inhalation with wheezing.
- Decreased breath sounds? - Possible pneumothorax.
May need a chest tube.
- Vitals? - I've got it.
Yeah, I'm sure you do.
Get a chest x-ray and show it to me.
Digital escarotomy.
Yeah.
He needs the same on the left.
I agree.
How old do you think she is? I don't know.
Young.
- Hey, Dr.
Corday.
- Yeah? What have you got? Urine's 60 an hour.
But it's bloody.
Eighty percent burns.
She'll need Send out for CT abdomen and pelvis.
I still need to do an airway.
- Dr.
Corday? - Yes? I'm Paul Nathan.
I was supposed to begin my surgical rotation.
Yes, you were.
She's got a critical patient next door.
- Where should I put these? - Here.
Put them there.
No free fluid.
- Liver and spleen look okay.
- Scope is prepped.
- Standing by with a number-five Shiley.
- Rounds started at 7 a.
m.
- No, I know.
I was at my- - Not interested in excuses, thanks.
- Get my letter? - Let's take a look.
- Dr.
Corday, your nanny's on the phone.
- For God's sake.
Take a look around.
- Take a message.
- I did.
She said to remind you - she has a flight to catch at 10:30.
- I can't leave now, can I? - What do you want me to tell her? - To bring Ella here.
Daycare's closed, you know.
- I know.
- Pulse ox, 81.
- He's throwing PVCs.
Crike him.
- Anything I can do? Yes.
Be quiet.
Okay, bag him.
You wanna make up for it? Go out there and work up some patients.
- Yeah, but-? - Wanna be a doctor? - That's why you' re here? - Yes- Grab a patient, do an H & P.
Present the case to an Attending.
I told Martin 100 times.
You need to put new batteries in the smoke detector.
But, oh, no.
God forbid he should spend $3 on a 9-volt.
The whole building could've burned down.
- His x-rays are back.
- Oh, okay.
Good.
- How's he doing? - Better than most.
- Yeah.
- Okay.
Next time I go hiking - I'm wearing long pants.
- And bug repellent.
Your infection's spreading.
- Is everything okay? - I'll be right back.
- Excuse me.
You're a surgeon? - That's the rumor.
- Think there's something you should see.
- You're a student.
- You haven't learned to think yet.
- I've got a rapidly spreading cellulitis.
- Excuse me.
How rapid? - Well, I just drew this 20 minutes ago.
And look.
This looks like sub-Q air consistent with neck fash.
Yeah, nice catch.
Let's roll.
Get that side.
- We gotta move him upstairs.
- Upstairs? - To Surgery.
What's he on? - Three grams of Unasyn.
Switch him to 6 million units of pen G and 900 of clinda.
- Where's he going? - He caught a neck fash.
- What? - What's that mean? Your boyfriend may have necrotizing fasciitis, a virulent skin infection.
- They gave him antibiotics to help.
- The infection's spreading fast.
Wait, what are you gonna do? Take you to O.
R.
and remove the infected tissue.
- What? - Everybody off.
Off the elevator.
Take the stairs next time.
You'll live longer.
If we don't stop this, it'll move along and you'll develop an infection, which will lower your blood pressure.
You could die.
Oh, my God.
- Think we caught that in time? - I hope so.
Thank you.
I'm Susan Lewis.
Paul Nathan.
- You coming? - In a minute, yeah.
- You okay? - Yeah.
It's just- It takes me a moment to get going sometimes.
I have Parkinson's disease.
- Get up here.
- I'll be up in five minutes, Robert.
You said that ten minutes ago! - I'm with a critical patient.
- Find somebody else now, Lizzie! Good ET placement.
No infiltrates.
Check ABG, repeat CBC and work on a burn-unit bed.
- What about him? - Who? - Him.
- Yeah.
What about him? Pardon me.
I found your CPK, lytes and UA results.
You headed up to surgery on the neck fash? Yes, as a matter of fact.
- Okay.
Well, I guess we' re done here.
- I am.
You still owe eight hours.
- I'm on rounds at 6 a.
m.
- Welcome to Surgery.
Excuse me.
Where can I find somebody who was brought in? Admit.
Come here.
Follow me.
Who are you looking for? Wynn Mathison.
He's in a tiger costume.
- There was a fire in our building.
- Could you direct me to the victims? - Keep your habit on, man.
- Excuse me? You'll soon see your drag queen friends.
I have food and housing vouchers for the displaced.
- Oh, I'm sorry, sister.
- Please tell me what room he's in.
- What? - He's with the guy in the tiger mask.
Get some oil of wintergreen.
I hate the smell of rotting flesh, especially when it's increasing.
Bacteria's moving faster than you.
- Bovie.
- Systolic's down to 95.
Bolus 500.
Lap pad.
Still not bleeding.
Myonecrosis.
- It's in the muscle.
- Ten blade.
- If it's vascularized, don't cut it.
- That's my plan.
Start there and carry the incision four centimeters inferior.
- No.
That's eight.
Goddamn it! - We need clean borders.
- Where the hell is Corday? - In the scrub room.
If I don't remove tissue, the infection could be left to smolder.
Get her.
Maybe she can débride this guy's wound without using a chain saw.
- Hey! - Kris, it's me.
Elizabeth.
Don't come.
I shouldn't be longer than an hour.
- Dr.
Corday, he's asking for you.
- Be right there.
Okay, but could you take Ella to your house to finish packing? Yeah, I could pick you both up after work.
I could drive you to the airport, save you the cost of cab fare.
Yeah.
Okay.
Thank you.
Thank you so much.
Yeah.
I'll see you soon.
Corazon, would you mind taking the phone? Not at all.
Damn.
Was that your wedding ring? Yep.
Yeah.
I can't see it.
Can you call Engineering? They' re closed till morning.
I'm sorry.
- No, it's not your fault.
- Don't hate me.
He wants to talk.
- Lizzie, get your ass in here.
- I've lost my wedding ring.
Oh, boohoo.
This guy's about to lose a leg.
I'd say chop-chop, but that'd be in extremely bad taste.
Call someone, get them to tape this off for me - make sure no water's run down it.
- Sure.
Would somebody please call Tiffany's search-and-rescue team? I'm coming! He's got 20 percent surface-area burns, mainly upper body.
- Oh, God.
- Decent prognosis.
We provide ventilatory support until lungs heal, then extubate him.
Might take a week, maybe less.
What-? What about his face? He'll need skin grafts.
There'll definitely be some scarring.
Wynn? Wynn, it's me, Terry.
I'm right here.
He can't hear you.
He's sedated.
- You should have your eye looked at.
- Later, okay? Can I touch him? I wouldn't.
Yo, newbie.
Come on.
Check jungle perv's eye.
He may have a corneal burn.
- Where's that? - You still here? Yeah.
Slit lamp.
Where is it? How does it work? Exam 3.
Try the on-off switch.
Hey, hey.
- You changed.
- I just put on scrub pants.
Oh, come on.
You know, Carter, my outfit is really starting to bug me too.
- We agreed to stay in costume all shift.
- I am.
No, you' re not.
It's half a costume.
- It's 50 percent commitment.
- Are you serious or kidding? - Do you know what I'm dealing with? - Me too, in pumps.
- Wanna see the whole costume? - No.
- That's all right.
Forget it.
- I'm a skeleton.
Look at me.
- Carter really likes Halloween, huh? - Perpetual erection.
Drank his daughter's mandrake smoothie.
Police found him chasing women.
- Where do you want him? - In a cold shower.
- Get a line in and push four of Ativan.
- Are you open, baby? Perfect.
First-day labs, charcoal, and a Foley for the tox screen.
Release me.
I am the Marquis de Sade.
How am I supposed to pass a catheter through that? - Inject phenylephrine.
- Into the shaft? I'm Rod Stewart.
Won't hold still for a blood draw much less let me touch his penis.
- She can touch it.
- Or wait for the mandrake to metabolize.
Why not give him Haldol? Make it easier.
Might make him worse.
- Hey, hey.
- Hey.
He just grabbed my ass.
- I couldn't reach hers.
- I said four of Ativan.
Ask Abby.
I'm done.
Okay.
You could be a little bit more sensitive.
To what? - Amazing how quickly this spreads.
- Any idea how he got it? A cut, a scratch, some other trivial injury.
- Dopamine's at 10 mics.
- More suction.
- Scalpel.
- Easy, Lizzie.
Is it just me or is this constant commentary distracting? - It's not you.
- Just remove the infected tissue.
Let antibiotics and hyperbaric oxygen do the rest.
- You' re not serious.
- Hell, yes.
I am.
I'm in posterior compartment.
It's still necrotic soup.
Six hours in a chamber will increase oxygen saturation create a bacteriocidal effect.
Give this guy a chance of a functioning leg.
You two have a problem with that? How's a guy with Parkinson's get into med school? Probably some disability quota they have to fill.
Med school? How's he expect to practice? - Don't want him taking out my appendix.
- He seems to have it under control.
It's a progressive disease.
What about in 10 years? - Could be dead.
- Or wanna be.
Happy, Abby.
Always looking on the bright side.
I thought you were out sick.
I was until an apartment fire set us back 30 patients.
- Thirty-five, counting bad popcorn balls.
- Wonderful.
- Thanks for coming in.
- Shouldn't have answered.
- Want your messages? - No.
I want the air conditioning on.
- I'm sweating like a pig.
- It's freezing.
That's what you get bringing Weaver in on Halloween.
- It's the biggest holiday for her kind.
- Lesbians? Wiccans.
Probably riding that crutch like a broom.
Frank, all women get like that when they' re going through the change.
- Yeah, right.
- Pratt.
What? She's having hot flashes.
She's moody.
- That is so sexist.
- And stupid.
She's too young.
- Early onset.
- You've got early onset.
Whatever you say, Nasty Ratched.
It's nurse, okay? Not nasty, not naughty, not wet, certainly not had.
Just nurse.
- Abby, you' re gonna talk to Kovac, right? - Yes.
- County General on Bravo One.
- Rescue One Finished the slit lamp, numbed him with Alcaine.
Who are you? Meet Nathan, our newest, oldest med student.
- I'm on surgical rotation with Dr.
Corday.
- We have to clear Trauma.
- BOA with newborn hypoxia.
- She asked that I stay and assist in- Good.
Follow me.
Don't worry.
She doesn't bite.
Much.
Simone Phillip, 42.
Had a home birth.
Newborn in respiratory distress.
- Did you have a complicated labor? - No, it went well.
I didn't even tear.
One minute Apgar was seven.
But he had a little- - Who are you? - The midwife.
- What's wrong with him? - We'll find out.
Take him to Trauma 1.
- Where is that? - I'll take him.
- No, I- It's okay.
- I got it.
I got it.
I got it.
- Simone, you've lost a lot of blood.
- Something's wrong with my baby.
Lily, stirrups.
Gallant, labs.
- Maybe I should've had him in a hospital.
- You did everything right.
- CBC, PT, PTT, DIC screen for four units.
- We' re taking care of your baby.
- Let's help you now.
- BP's 80/60.
- Squeeze in another two liters.
- What's happening? Blood loss from a retained placenta.
- No, I mean with my baby.
- Dr.
Kovac is taking care of your son.
I'm gonna pull gently on the umbilical cord.
Simone? I need you to stay with me.
Pulse ox is 82.
He's retracting.
Pedes intubation tray, number three ET, uncuffed.
What do you hear? Wet crackles throughout.
Fluid in the alveoli.
Okay, let's go look.
Unhook the bag from the mask.
You can bag the ET once I'm in.
- I've never done that.
- Squeeze the bag every two seconds just like he was doing.
Never pass the tube till you see the cords.
Okay.
I'm in.
Call for a Pedes vent.
And set me up for an umbilical line.
Relax, relax.
The hard part's over.
Good.
Notify the NICU team.
- What do I tell them's wrong? - I have no idea.
It's no good.
We' re into the cords.
- Have to do an AKA.
- Keep débriding.
We' re not there yet.
We treat this conservatively and it spreads then it's hip disarticulation to stay ahead of bacteria.
- Worth the risk.
- Of his being non-ambulatory? Above-the-knee amputation.
He can use a prosthetic.
If it gets to his hip, it'll spread to the abdominal wall.
He'll get septic.
I'm trying to save this man's leg.
Dry the field.
- What about his life? - He's young.
Same thing.
Come on, Robert.
Of course it's not.
Look.
This Kelly slices through sub-Q fat like butter.
Fine.
Keep cutting until you hit viable muscle.
It's above the distal third of the thigh.
It's a hopeless wound.
- Fine, take it.
- Robert.
I said, take the leg.
Bovie, pickups.
Tommy, how are you feeling? He seems- He seems a lot better, thanks.
Good.
Well just keep him on clear fluids tonight and I'll have a nurse sign you out.
Okay.
- What's wrong with him? - We'll- We'll talk about it later.
- How are you holding up? - Good.
I think the robot can go home.
- Okay.
I'll get Carter to dispo him.
- Okay.
- Can I get you a cup of coffee? - No, I'm fine.
Thank you.
I like your outfit.
It's very retro.
Thank you.
Listen, if- If you ever need anything, like a Like a straitjacket? Is your dyskinesia usually this bad? I don't wanna freeze up on them at work so I upped the medication.
And this is what you get.
At least it helps to dispel the myth.
You know, we don't all have rhythm.
If it happened to me, I'd probably jump on a world cruise, not go to med school.
I already saw the world.
In fact, I was in Italy when I first realized I had a problem.
Sipping wine in this café in Florence, and I noticed my little finger shaking.
I just figured it was from living on espresso and martinis.
When did you find out it wasn't? Well, I used to hate doctors so it took a while for me to check it out.
But once I did, it really put things in perspective.
Yeah, I guess being sick does that.
- Her baby's not doing well, huh? - No.
- How are you doing, Simone? - Good.
He seems better, huh? Maintenance fluids are at five cc's per kilo per hour.
My mother had me at home.
I thought it would be good for him.
His tests came back.
I'm afraid your baby has a disease called sialidosis.
What's that? His body lacks an enzyme that breaks down the waste proteins inside the cells.
And there is already extensive damage to the liver, bones and nervous system.
I've been staring at him for over an hour now.
And I still can't figure out what I wanna call him.
Would you excuse us, please? Yeah.
Sure.
Children with sialidosis are mentally retarded, often blind.
He'll never speak or walk.
His life expectancy is less than two years.
Dr.
Kovac, NICU is on line one.
Thanks.
Excuse me.
Is there anyone you'd like me to call? No.
There's just us.
I don't think it'll be necessary.
Thank you.
- You having a bad night? - No worse than usual.
That was a little bit insensitive.
I had to tell a mother her baby was gonna die.
- I didn't need an audience? Okay? - Okay.
I'm starting to get some complaints about you.
- From patients? - Nurses.
Don't look so concerned about it.
First you accused Chuny of being an idiot.
When she's sexually harassed - you practically laughed.
- The guy grabbed her butt.
- Yeah, that's sexual harassment.
- Come on.
You were there.
The guy's intoxicated with mandrake.
He's harmless.
- This one's all yours.
- What patient? Mr.
Hard-On.
Checking his vitals and he grabbed my boob.
- What's his status? - Gonna die if he tries again.
- That's his status.
- See? Every time there's a problem, she complains.
Everyone complains.
It's part of the job.
Yes.
And it's part of my job as nurse manager to counsel you.
What? You can give nurses orders, but cannot critique.
If you have a problem with a nurse, come to me.
Okay.
What about you? Who do I complain to if I have a problem-? Here's an idea.
Maybe you should try fighting for the nurses - instead of fighting with them.
- Maybe you should sew swastikas on that costume.
You could be a naughty Nazi nurse, huh? - You totally suck, you know that? - Creating a hostile work environment.
- Where's Dr.
Kovac? - I don't know.
Page him.
The baby with sialidosis is febrile to 102.
- Chuny, where's Kovac? - Don't know, don't care.
- Feels like he's on fire.
- Why hasn't he gone to the NICU? - You'd have to ask Dr.
Kovac.
- Can you do something? He needs to be pan-cultured.
How much does he weigh? - Three kilos.
- A hundred and fifty milligrams IV piggyback of Cefotaxime and amp.
Set up for a spinal tap.
- He has sialidosis.
- Yeah.
And he also has an infection.
Sixty mgs of Tylenol.
I'll arrange for your baby to be sent up to the neonatal unit.
- We'll do everything we can for you.
- Thank you.
Why are you still here? My piano recital was canceled.
Hey, it's me, Elizabeth.
I'm on my way home now.
See you soon.
Bye.
We did the right thing.
You trying to convince me or you? I went through a period of adjustment when I became a mother, every time I treated a child.
You get over it.
Oh, please spare me the $2 psychoanalysis, Lizzie.
- Fine.
- Hey, look, look.
I know most people don't like me.
I don't care.
I don't like most people.
But I'm good at what I do.
I save people's lives every day.
People who no one else can help.
If I can't do that Robert I know you' re frustrated.
You' re an excellent surgeon, and you will be again.
I promise you.
You will be.
- I'm being paged.
- Elizabeth.
I'm being paged.
- Elizabeth.
- I just tried calling you.
I'm sorry.
I have to leave for the airport now.
- What about the later flight? - This is it.
I threw her pajamas, some crackers, a couple toys in here in case she had to stay for a while.
I'm sorry.
No.
It's all right.
It's my fault.
We got slammed.
I'll see you Monday morning.
- Yeah, yeah.
Have a safe flight.
- Okay.
Bye, Ella.
Hey, did Kris take you trick-or-treating? - What is it? - Dropped her pressure to 60 palp.
Dopamine is up.
We got two liters.
I'm working on an art line.
- Any word from her family? - No.
We don't have her last name.
- Lily, could you? - Oh, sure.
- There, it's okay.
- Hello, little cow - girl.
- I'll be with you soon, all right? - Could it be hemorrhagic? - The CT was negative.
I'm thinking hypoxia.
If we don't find her family, they'll be ID'ing the body.
Pulse ox is only 82 on 100 percent.
She needs suctioning, Abby.
Set up ultrasound.
- She may have blown a clot.
- I don't know.
Second crit was only 32.
- What happened to Mom? - In the washroom.
- Where are the suction catheters? - Try the cabinet.
- What are you doing? - Weaver ordered antibiotics.
- No.
Who did the LP? - She wanted a full septic workup.
- This is my patient.
- The baby spiked a fever.
This baby is in a chronic vegetative state.
You' re prolonging his and the mother's suffering.
- We treat kids like this.
- You should've asked me.
- We couldn't find you.
- I told you to leave.
This isn't your case.
- Luka.
- Abby? Check with me before you push meds on my patient.
- I have to do a cutdown here.
- Morrison's pouch looks dry.
It could be retroperitoneal.
What the hell was all that about? - You want PEEP on the vent? - Not until we get her pressure up.
Nathan, why do you think she's hypotensive? - Blood loss? - Not in this case.
Hypoxia can cause myocardial dysfunction.
I'm filing a grievance against him.
Not now, Chuny.
IV's dry.
She needs a fresh one.
- I'll get it.
- Panic value.
Potassium is 8.
2.
Damn.
Rhabdo from the crush injury.
Ten cc's of calcium gluconate.
- PVCs.
- Let's push bicarb.
Ten units of regular insulin and an amp of D50.
Get me Kayexalate and call Renal.
She may need dialysis.
- What the hell are you doing? - I accidentally- It's okay.
- Go see if Frank's found the girl's family.
- I'll start another.
- Transducer ready? - Where's the saline? - I said, go find the girl's family.
- Run of five.
- Hundred of lidocaine.
Prep the groin.
- Pressure falling, 79.
Pressure's down to 50.
- Being a little hard on him, you think? - V-tach.
Charge to 200.
- What are you talking about? - He's doing a good job, considering.
- Considering what? - He has Parkinson's.
Excuse me? Clear.
Still V-tach.
- Procainamide's onboard.
- Stand by with amiodarone.
Clear.
- No change.
- How long? - How long? - Twelve minutes.
Clear.
- Sinus tach.
- All right.
Way to go.
- Good femoral pulse.
- Set up a Pronestyl drip then a repeat K.
Labs on your baby.
- Thank you.
- Glad to see you two have made up.
Hey, I'm being professional and she's the one having trouble.
- I warned her.
- Warned her about what? Nothing.
Oh, my God.
- You' re such a jerk.
- What? You slept with her? That's what this is all about.
What's your problem? - Hey, one time.
- One time.
One time with Chuny.
One time with a patient's mother in Radiology.
Hey, you never complained.
I never let it affect my work.
You two need to figure this out.
- So what do you want me to do? - Tell her you' re sorry.
- Tell her it was wrong.
Just fix it.
- I'm not gonna kiss her ass.
That's how this problem started.
- Have them check a gas on 50 percent.
- I'm gonna wait right here for you.
Don't worry about anything.
I love you.
I should've told them I was his brother.
ICU has strict rules.
He'll need round-the-clock attention tonight, but his lungs are rebounding.
You know what? You should go home.
They'll let you see him in the morning.
Home? Our whole lives were in that apartment.
This dress is all I have.
I've been watching his heart rate.
It goes down when I touch him when he knows I'm here.
- Has his fever gone down? - A little.
I waited so long for him.
Five years.
Two miscarriages, in vitro.
I lost two boyfriends because I was so determined to have a child.
I was about to give up.
And then suddenly he was here.
- He's here.
- We'll keep treating the infection but he will start going into organ failure soon.
His systems will shut down.
You' re so beautiful.
You' re my baby.
His heart could stop beating.
I need to know what you wanna do if something like that happens.
I don't know.
To keep him alive, I may have to open his chest, maybe even shock him.
And I'm not sure you want me to do something like that.
No.
I don't know.
I don't know.
Tell the unit I flushed the Quinton.
He's tenacious.
Gotta give him that.
I wish he'd told me.
Not an easy thing to lead with.
There's Mommy.
There's Mommy.
Hi, Lily had to run Wynn's ABG up to the lab.
- Thank you.
- Did you reverse her hyperkalemia? Yeah.
Enough to get her to dialysis.
She still has the burns though.
- Yeah.
But you got her back.
- May I? - Oh, I'm sorry.
- Hey.
Thank you.
So did we reach the parents? No.
The girl was actually babysitting.
It wasn't even her building.
You might've told me sooner, saved me embarrassment about your condition.
Well, I certainly didn't mean to embarrass you.
- How long has it been? - Eight years.
I was misdiagnosed for the first two.
- And you were late today because? - My neurologist wanted an MRI.
I'm sorry.
I wouldn't have made you stay.
What the hell? Fresh start.
Try to make as many rounds as you can, complete the required reading take the exam.
I've been reading and taking tests for two years.
This is my hands-on training.
- It's a surgical rotation.
- I understand that.
Probably the most physically demanding emotionally exhausting, stressful six weeks, any would-be physician ever experiences.
Part of becoming a doctor.
I'm offering you a pass, Mr.
Nathan.
Trust me.
You should take it.
I'm here to treat patients.
You have a degenerative disease.
I know what I have.
It doesn't mean I need a pass.
ER.
I don't want special treatment.
I just want to learn like other students.
- Yeah, she's here.
- You're not like other students.
- No, I'm older and smarter.
- Okay.
Dr.
Corday, burn unit needs you.
- I'm on my way up, Frank.
- It's your melted-mask guy.
Okay.
Be right there.
- She's on her way.
- Look, go home, think about it report back day after tomorrow.
Use the rest.
- I'm fine.
- It's just not very practical.
Okay, let's go.
- Dr.
Weaver? - What? - What time is it? - Are you okay? Yeah.
Yeah, I was- - I was gonna lay down for a second.
- Can you pronounce a patient? Did we ever hear back from the NICU? - No.
There was no need.
- Oh, come on.
It's been three hours.
We can't board their patients.
They have to call in a nurse from home.
If they won't - I'll speak to their medical director.
- Dr.
Weaver Cardiac arrest a half-hour ago.
Excuse us.
You should've come to get me.
How long did Dr.
Kovac work on him? He didn't.
She signed a DNR.
Where is he? - Who? - Kovac.
He's home.
His shift ended at 10.
All right, I'm gonna move her to a quiet room.
Call the social worker and get her referrals for grief counseling.
Are you leaving soon? I'm just finishing up with Woody here.
You' re the most beautiful nurse in this hospital.
- Well, thank you.
- You've got class.
- May I play with your breasts? - Hey.
- Excuse me? - Please.
Last request of a man on his deathbed.
You' re not dying, Woody.
You' re drunk.
I wanna go to heaven on the bosom of a beautiful woman.
I don't think your HMO covers that.
How long you have that outfit? - Tomorrow at noon.
Why? - Maybe I could talk you into - giving me a sponge bath.
- What's in it for me, bony boy? I'll give you a bone, nasty, naughty little nurse.
Elizabeth.
Robert, can we talk tomorrow? I have to get Ella home.
I thought you might want this before you left.
It's my ring.
Amazing what you can do with a laparoscopic camera and a snare.
Thank you.
- Look, about today - Let's not.
It was a momentary weakness on my part.
It won't happen again.
You'll work through this, Robert.
Of course I will.
- Good night.
- Night.
The patient has gastroenteritis, vomits to excess has hematemesis, no history of PUD.
What are you thinking? Well? Mallory-Weiss tear.
Laceration of the distal esophagus results in an upper GI bleed.
You' re both correct and tardy.
- Sorry.
- Don't be sorry.
Be punctual.
What if that patient vomits and develops chest pain? Boerhaave's syndrome.
Spontaneous rupture of the esophagus associated with retching.
Usually tears into the left pleural space