ER s09e07 Episode Script
Tell Me Where It Hurts
Previously on E.
R.
Congratulations, Mr.
Nathan, youre on call tomorrow night.
Thirty-two hours straight.
Labs on your baby.
You two need to figure this out.
- I was gonna call first, but Jody got sick.
- Who's Jody? You show up with this girl who's barely out of her teens.
- Aren't you due back at the base? - Not for a couple weeks.
A couple weeks? There it is.
I can see his heartbeat.
You can tell it's a boy? Because I can't.
No, it's just a figure of speech.
Just a pronoun.
Are you hoping for a boy? Not particularly.
I mean, a boy would be nice but I don't care.
I don't even really wanna know.
As long as it's healthy, right? - The rash of Lyme disease is? - Erythema migrans.
- Starts two to 20 days after the tick bite.
- Occurs in 60 to 80 percent of cases.
- The hallmark of the rash is? - Erythematous plaque.
Yeah.
And the most common neurological symptoms? - Facial nerve palsy.
- Facial nerve palsy.
Okay.
All right.
Settle down.
This is a teaching hospital, not medical Jeopardy! - Where are all the doctors? - Who? Anyone.
Carter, Weaver, Pratt, I'm not picky.
Carter's stuck in Triage.
Pratt's on at midnight.
- And Weaver's MIA.
- What else is new? - Kovac is sleeping.
- With who? I thought he's suspended.
He's back.
In the lounge.
Harkins, wanna try casting a Colles' fracture on a cranky old lady? Sure.
- What's the antibiotic of choice? - Doxycycline! Beth, this is Erin.
She's gonna be putting your cast on.
Beth? Miss Garrison? - I can't feel a pulse.
- Oh, jeez! She's cold.
- She's dead? - Bag her on 15 liters.
I need a crash cart in here! - Sister Beth? - She was a nun? - She is.
- Oh, boy.
Nathan.
Nathan, let's shake a leg.
Come on.
Corday's looking for you, man.
Be right there.
ER, please hold.
Think you could take this somewhere else? - I need to use the computer.
- Use one over there.
I don't want you near me when God strikes you dead for killing that nun.
- I didn't kill her.
- You didn't save her.
She was an 87-year-old woman in poor health.
What, you only save the healthy ones? She stroked out.
No one could foresee that.
You don't have to explain to me.
I'm not the one doing the judging.
- GSW, 10 minutes out.
- I'll be right there.
Is Dr.
Corday still down here? John Doe.
Found in the park.
No signs of serious trauma.
Promise me you won't let them near my face.
Sir, what's your name? - They dropped right out of the trees- - We got good breath sounds.
- Nobody's near your face, sir.
- No, don't let them near me! Settle down! Okay, get five of Haldol- - Don't let them bite me! - Relax, sir.
- No, no.
We're trying to help you.
- Get Security! - It's the dyskinesia.
- Still need the Haldol? Yes.
We got it.
We're going to need a head CT.
- You okay? - Yeah.
I'm fine.
Thanks.
Are you okay? Nothing that 12 hours of sleep wouldn't cure.
Put him on pulse ox, two liters O-2 by nasal cannula.
Mineral oil on a cotton ball should act as a solvent.
Come on in.
Let's get him inside.
Make sure his nasal passages stay clear.
Hey, Jody.
What are you doing here? I'm looking for Eric.
Abby.
- Hi, Abby.
- Hey.
What's going on? - Where's Eric? - I was hoping you knew.
What do you mean? I don't know.
We were in Indiana on our way back from my parents' - - They had a fight.
- It was hardly an argument.
He got really angry.
I was just asking him about us, our future, stuff like that and he took off.
I didn't mean to upset him.
- Maybe he went back to his base.
- No, I called.
They said he's been UA for two weeks.
- UA? - Unauthorized absence.
Abby? - He's AWOL? - Yep.
Joel Seaton, 67, syncopal episode at Navy Pier.
Paramedics found him dehydrated, systolic of 90.
Came up with 500 of saline.
Joel was diagnosed with pancreatic cancer three months ago.
What treatment have you been on, Mr.
Seaton? Megace and Gemzol.
They said I might have a year with the chemo, but I'm not doing too good.
He's had two stents in his common bile duct to relieve the obstruction.
It's probably clogged, which explains the fever.
- How's your pain? - Every night I go to bed I keep hoping I'll wake up in the morning and I'll be better and the pain will be gone.
Think there's a surgical alternative that could help? I'm afraid not.
What happens if you don't do anything? You'll get more jaundiced, slip into a coma from liver failure.
Your kidneys will fail and your heart will stop from a high potassium level.
Is that a painful way to die? Not once you slip into the coma.
We can arrange for home hospice care.
A nurse will visit you twice a day to give you the pain medications.
When my wife was living, she used to always say I'd probably die in my Barcalounger watching the football game.
I'm starting to think that's not such a bad way to go.
Does that mean youre no longer interested in further treatment, Mr.
Seaton? Sorry.
Let's have Ativan now.
- I can't see.
I can't see.
- All right, just relax.
Need some flush? Did you try to kill yourself, Greg? No.
It was an accident.
He didn't mean it.
Page ENT and Ophtho.
Get a Wood's lamp and fluorescein.
- Who, Greg? Who shot you? - Tommy.
- Ativan's onboard.
- A friend? He's my brother.
He's 10.
Need a two view of the face along with a trauma panel.
Look at this light, Greg.
- Can you see this light? - A little.
- Where'd Tommy get the gun? - He was playing with our dad's gun.
I tried to take it away from him so he wouldn't hurt himself, but it went off.
We'll do everything we can to make you comfortable.
Thank you.
Let me know if there's anything else you need, okay? Thank you.
- We should have pursued other options.
- What? With Corday.
There are treatments to consider.
I asked for surgical consult.
She didn't think it was a good idea.
What if it's in the patient's best interest? You went up against Carter on a terminal patient.
That's not your job.
- You're a med student.
- This guy could just be having a bad day.
We try to do what's best for the patient and respect their wishes.
If were lucky, we get to do both.
This is one of those times.
Have Pedes page me and get me that Ophtho consult.
Dr.
Kovac.
Mike Dobbs.
I think you know my wife, Heather.
Look, we've been having some rough times recently but I'd appreciate it if you'd stop seeing her.
- You should speak to your wife about it.
- Yeah, I did.
Are you married? I was.
Then you know how hard it can be.
Look, I'm not trying to threaten you or anything, man, but I got two daughters.
What do I tell them when their mother doesn't come home at night? I don't know.
Just trying to keep my family together, that's all.
Hey, Eric, it's me again.
Listen, could you please call me back? You don't have to talk to me.
Just leave a message on my machine, I'd appreciate it.
Thank you.
Looks like your day's sucking as bad as mine.
Yeah.
I'm worried about my brother.
I can't get in touch with him.
At least you haven't killed anyone.
I'm 0 for 2.
All these patients could be my next victim.
I think I have the crabs and it itches bad.
" - So youre not taking the chest pain in 4? - Not if he wants to live.
Guy in Exam 2 with scrotal swelling.
Pretty safe bet.
- I'm not that desperate.
- At least it's medical.
- He's pushing 300 pounds! - It's a big scrotum.
He's a heart attack waiting to happen.
Half these patients are.
Old, diabetic, old, old and diabetic.
- Did you reach him yet? - No, I get his voice mail.
Oh, screw it.
Give me the swollen scrotum.
Maybe he's off with a buddy or something.
Dr.
Carter, could you reassess my allergic reaction in 2? - I'll be right there.
- Where's Jody? She's checking into a hotel.
- Wanna get coffee? - He didn't respond to Benadryl.
- Try Solu-Medrol.
- I did.
He's still wheezing.
- Try an albuterol treatment.
- It didn't work.
Should I push an IV epi? - I'll be right back.
What are his sats? - Eighty-three on oxygen.
- Why didn't you come get me? - I just did.
- Base operations.
- Medical facility, please.
One moment.
Medical.
I'm from Chicago's County General Emergency Department.
Were treating a patient from your base, Eric Wyczenski.
Were gonna need his medical records faxed over.
- Yes, ma'am.
Who's his doctor? - I don't have the chart in front of me.
- Does it matter who the doctor is? - Yes.
- We can't release his records otherwise.
- Okay, just a second.
The physician's name is Dr.
John Carter.
Dr.
John Carter.
Thank you, ma'am.
- Excuse me.
- It's okay.
How are you feeling, Greg? My eyes hurt.
Can you see anything? No.
Hey, Chuny? - Yeah? - I'm sorry.
About everything.
Me too.
Am I blind? You have a shotgun pellet inside your eyeball.
Were bringing in an eye specialist to repair it.
Youre lucky.
You could've blown your head off.
My dad would be less mad at me if I was dead.
He shouldn't be angry with you at all.
You probably saved your brother's life.
- Hey, can I talk to you for a second? - Shoot.
Carter! Carter! - Is there anything wrong with him? - Not that I can tell.
Neighbor heard the baby crying.
Found Mom in the backyard, kid in the swing.
Mom's got no sign of trauma.
Could be a possible mixed OD.
GCS, 415, but she's uncooperative.
- BP, 122/78.
Pulse, 84.
- Okay.
What's her name? Neighbor wasn't sure, thought it was Tenji or Tong-yi.
- She didn't have ID.
- Ma'am, can you tell me your name? I have a 16-year-old boy who's gonna go blind if he doesn't get here fast.
Tell me where he is so I can call for some initial orders.
- He's on the golf course.
- He's where? He's playing golf at the country club.
Eyes open to painful stimuli.
- Is your name Tenji? Or Tong-yi? - Is she oriented to person? - Her little boy's fine.
- Does she understand English? Gag reflex is present.
I smell alcohol on her breath.
- Got your bloods.
- Okay, what do you want? - CBC, lytes, ET OH.
- Aspirin and acetaminophen levels.
Hello? Eric! - What about charcoal? - Where are you? The 2001 recommendations from Clinical Toxicology - didn't support the administration - I need to talk to you.
- She can't tell us when she took it.
- Twenty-five of charcoal.
I need some Surgilube and an NG tube.
Abby, she needs a Foley, tox screen.
- Damn it.
- And let's change the saline to D-five - half at 75 an hour.
- Hello? Blunted deep tendon reflexes.
Could be benzos.
- Should we try Flumazenil? - Only if you want her to start seizing.
- Did you lose him? - Yeah.
I lost him.
It's not unusual to experience these feelings when dealing with chronic illness.
Mr.
Nathan, may I have a word? Excuse me.
- What's he doing in there? - That's Dr.
Harvey.
- He's the Attending psych- - I know.
I asked you what he's doing.
He was on a psych consult on another patient and I asked if he would speak with Mr.
Seaton.
- Did you run this by Dr.
Lewis? - No.
Dr.
Harvey agreed.
Mr.
Seaton was depressed and wasn't objective about his own treatment.
- He's refused treatment.
- He's willing to consider other options.
- A Whipple, for instance- - A Whipple? No.
Please don't tell me you suggested a Whipple for this patient.
I'm not sure who brought it up.
Well, whoever did must be utterly insane because nobody in their right mind would suggest a 6-hour operation.
An operation that requires months of recovery, assuming he ever recovers.
- And for what? - He's dead in 2 months if we do nothing.
That's right.
But only you seem to be unwilling to accept that.
Well, shouldn't we at least present him with all the facts and let him decide? You've done enough, thank you.
Normal vitals, satting well on room air.
- You get your phone working? - No.
Tox screen is positive for barbiturates.
Blood alcohol level's only.
065.
Urine dip's negative, but ICON's positive.
She's coming around.
Ma'am? Do you know that you' re pregnant? You speak English? Where's Chen? Maybe she can translate for us.
I wanna rule out an ectopic.
Where is the portable ultrasound? - I'll get it.
Can I do it? - Yeah.
I'll be right back.
I'm sorry, but it was right in the middle of a trauma.
Maybe he'll call back.
- Check your home machine? - No.
I didn't have a chance to.
Well, how did he sound? Depends on who you ask.
Sounds great.
He's happy, he's carefree, he's having the time of his life.
Just the fact that he called is a pretty good sign.
Yeah, he's manic, Carter.
Say, Abby, here's two of the country's finest looking for a patient.
I'm Sergeant Andrews with the Air Force Office of Special Investigation.
I understand you' re treating Eric Wyczenski.
No.
We were, but we' re not now.
He left against medical advice.
Any idea where he may be going? I'm sorry we can't be more helpful, but we have an emergency.
- What about the doctor who treated him? - He's upstairs.
If you leave your card, we'll call you if he shows up again.
- What was that all about? - I was about to tell you.
These are your brother's medical records? I said we were treating him.
You'd still require his signature.
And a written request from his Attending physician which in this case was You forged my name too? - We could get into trouble for this.
- Just read it.
No.
I have no right to read this, and neither do you.
He took a leave of absence for stress following a near-miss incident.
Yeah, so? He's an air-traffic controller.
- It's a stressful job.
- He had therapy but wasn't medicated.
Probably no reason to.
Just a reaction to the event.
What if it isn't PTSD? What if it was depression? The initial presentation of a bipolar disorder? - He's too old.
- He's under 30.
Well, then he'd be at the far end of the curve.
He's been suffering from insomnia, lack of appetite.
- Both of which are consistent with PTSD.
- Six months ago he was depressed.
Now he's cycling up to a manic phase.
The timing is perfect.
I know.
- Why didn't the Air Force catch it? - They' re not looking for it.
Look.
"No family history of psychiatric disorders.
"He's lying to the doctors.
Just like you did to get those records.
- I thought this was a surgical consult.
- It was.
- What happened? - Fat lady sang.
Fat man, in this case.
We did everything but order him a deep-dish pizza.
Yeah.
Just say no to drugs and double bacon cheeseburgers.
His size is probably something that he couldn't control.
Certainly not if he was running downhill.
- Nathan, we didn't mean to offend you.
- You didn't.
- I'm sorry.
I'm having a really bad day.
- Not as bad as him.
- What the hell is that? - I don't know.
- You can't drive on here, you idiot.
- Which one of you is Dr.
Abrams? - I'm Abrams.
- You need to come with me now.
I've got a 14-year-old boy with a ruptured globe.
He may lose his eyesight because you didn't answer your page.
You' re insane.
- Get in the car.
- Get out of here.
- Get in the car now! - You don't have to listen to this guy, Vic.
- Are you a doctor? - An oral surgeon.
- Then shut up.
Let's go! - What about my clubs? You, take his clubs.
You' re doing a good job clearing the patients.
Easy to be fast when you' re just killing them.
- I'm gonna be taking some time off.
- Yeah? For what? Just to deal with some personal things I've been putting off for a while.
With Romano out of commission you'll probably be the one forced to pick up the slack.
Bad idea.
Do you mind? We' re having a conversation here.
- I don't mind.
- Well, I do.
I mind.
I mind your insinuations and your smart-ass comments.
This is an ER.
People come here because it's an emergency.
Guess what.
Some of these people are gonna die.
I've saved hundreds of lives.
- Dr.
Lewis.
- Yeah.
You know that drunk you intubated this morning? - He asked to take his tube out.
- He can't talk if he's intubated.
I think you better come.
He's gonna vomit and aspirate.
Twenty bucks says she kills this guy too.
- Frank, did my brother call? - Nope.
- Are you sure? - Let me double-check.
Nope.
Hey, Abby.
Tell Abby what you just told me.
An unauthorized absence can be a serious offense.
But if it's a first offense and you can prove extenuating circumstances you can get off with minimum punishment.
That's good to know.
Thanks.
- Do you have a minute? - Yeah.
Thanks.
Your girlfriend, Harkins, was looking for you.
Why are you talking about my brother to med students? Gallant's in the Army.
I'm trying to get information.
You didn't have to say it was my brother.
Excuse me, Carter.
This is Mr.
and Mrs.
Yeung.
Their child was brought in.
- Which one? - The 3-year-old with your patient.
Oh, I'm sorry.
I thought she was the mother.
No.
Tong-yi's our nanny.
I'm Aidan's mother.
- Is our son okay? - Yeah, he's fine.
Chuny, you can take Mrs.
Yeung to see her son.
Sir, if I can just ask you a couple questions first? Yeah.
Okay.
- Is Tong-yi a drug user? - No.
- Has she been depressed? - No.
Can you think of any reason why she would hurt herself? She wouldn't do that.
She tested positive for barbiturates and alcohol.
Well, she's been up all week with Aidan.
He had an earache.
She might've taken some sleeping pills, maybe a glass of wine but she's not suicidal.
Does she have a boyfriend? I don't think so.
- Why? - I just- I don't know.
Maybe she's got some problems in her personal life.
Well, if she did, we'd probably know.
She lives with us, has been for four years now.
Can I see her? - You wanted to see me? - Did you review Zollinger? - Was I supposed to? - He's under.
- Thanks, Shirley.
- Are we gonna do a Whipple on him? - He's a little old.
- Thought you didn't wanna do this.
I didn't, but thanks to you he and his family seem to think the operation is worth the risk.
They may have second thoughts after we resect his pancreas duodenum, gall bladder and a portion of his stomach.
He's got a daughter and grandchildren.
Any extra time he gets, he could spend with them.
- He could get up to a year from this.
- Perhaps.
If it comes with a small miracle.
Which may be in order seeing as you seem to have become the patron saint of the terminally ill.
You prepared to assist? - Really? - You got us into this.
We' re still running some tests.
Okay.
Sonosite is ready.
I need both trauma rooms.
Double MVA en route.
Auto versus motorcycle.
- Can I take these two? - Yeah.
Grab trauma gowns and gloves.
Come on.
- Can we take her home? - She should stay for observation.
In that case, I'd like to have her moved to a private facility.
Would you ask her why she did it? She's not depressed.
It was an accident.
She took a couple of sleeping pills with a glass of wine to help her sleep.
And she's sorry to have caused you any trouble.
- She said all that? - Yes.
Suction here so I can see the field.
Are you okay? I've been up for 24 hours.
It throws off my meds.
Does it usually bleed this much? There are numerous branches off the superior mesenteric artery.
Hemostat.
Do we tie off or bovie? Pressure's down to 90/60.
Okay.
Bolus a liter and check a crit.
Like this? You need to isolate the source of the bleeding.
Come on, Nathan.
I need better exposure.
Stop! Stop! You' re up against the portal vein.
Pull out before you tear the wall and kill him.
- Shirley, take over, please.
- Just tell me what to do.
I'm trying.
Shirley, suction.
- What was that? - T-tube for the common bile duct.
- Do we have another tray? - We can autoclave this one.
I don't have 30 minutes to wait for this.
- Tell me what you want me to do.
- Nothing.
Shirley, pick up the instruments, get them re-sterilized.
This will pass in about an hour.
Carl Vanosh, 32, motorcycle driver versus stakebed truck.
Extracted.
- Unable to breathe for four minutes.
- Violaceous discoloration.
Classic traumatic asphyxia.
Get an ABG and full trauma panel.
I'll meet you inside.
- This the driver of the truck? - Motorcycle passenger.
Quinn Vanosh, 11.
BP falling after two liters Nobody told me they were bringing in a kid.
He's tachy to the mid-120s.
We were gonna tube him.
Go get one of the Attendings.
Anyone.
Who's that? - I thought you were treating her.
- I am.
Dr.
Chen is translating for me.
- I should be doing that.
- That's okay.
We' re a full-service facility.
- She didn't know she was pregnant.
- Did she say who the father is? No.
- Ask her if she's sleeping with her boss.
- What? Ask her if she's sleeping with him.
CBC and lytes, crit times three, Chem-7, urine and Foley.
- He's got Tardieu's spots.
- Tardieu? - Facial petechiae.
What fell on him? - A truck.
Crepitus over left chest, tender pelvis.
- Sats, 93.
- It hurts to breathe.
- Kerry, I need help in here.
- Quinn? What's wrong? Left breath decreased with right tracheal shift.
- Sux and Fent are in.
Sats are still 90.
- Needs a central line and a chest tube.
You' re doing fine, Susan.
Just take a deep breath.
Decreased on the right as well.
He's got tension pneumos.
- What's wrong with my son? - We' re working on him.
Malik.
- What do you want me to do? - Bag him up.
- Ectopy.
- Don't do this to me, kid.
Your wife seems upset.
She's worrying about Aidan and Tong-yi, that's all.
Well, our doctor's coming to move her to another facility.
What was your relationship with Tong-yi again? I told you, she works for us.
Right.
She's lived with you for four years? Have you been sleeping with her? Have you been having sex with her? Because she's pregnant and she says the baby's yours.
Even if that were true, doctor, it's none of your business.
No, it is.
It was my business the minute she became my patient.
She won't be your patient much longer.
Hey, Carter! Eric, where have you been? Everybody's been worried about you.
- Come inside.
- Oh, Jody was driving me nuts! Nothing like a road trip to bring out a person's issues.
" Please limit your baggage to two items.
" She must've peed 1000 times between here and Indianapolis.
She's worse than a beagle.
Probably got a bladder thing.
- Wait.
I thought you guys flew.
- We were.
Until she got airsick.
Airsick, carsick, homesick.
The girl gets sick a lot.
Which supposedly runs in her family.
Don't get me started on her parents.
If she turns out to be anything like her mother she's gonna be too much woman for me to handle.
She's big.
Like sumo big, minus the agility.
- I'll come later to see how you're doing.
- Will you talk to my dad? I'll do even better.
I'll convince him you're a hero.
- The in-house team could have done this.
- You' re the retinal specialist.
According to the CT, the other eye has a pellet in it too.
I can't promise I'll be able to save his sight in that eye.
- Perhaps if you'd have come here sooner.
- Ophthalmology isn't emergency medicine.
You know, some guys wait a week to do this kind of surgery.
You know, all you did was stop me from shooting an 82.
Tell it to him.
- Luka, Dr.
Lewis needs you in Trauma 1.
- Oh, thanks.
So I'm in a position where I can buy the Cessna or two planes that need some fixing up for the same price.
- I've been calling you.
- So I hear.
I'm sorry Jody dragged you into this.
She's immature.
She likes the drama.
It's the Jerry Springer generation, you know? You were supposed to be at your base two weeks ago.
- Did they call here? - No.
That's the second time this year somebody's messed up my leave.
I'll have to report for duty on Monday.
We should do something crazy! Wanna go somewhere? How about you, me and Carter fly to Vegas.
We could do a little gambling, maybe hit an Elvis wedding chapel.
"You may now kiss the bride.
Thank you very-" Just come here.
Just stop it.
They said you' re suffering from post-traumatic stress? It was nothing.
They cleared me.
Every controller's had a couple PTSD assessments.
It's our way of working the system to get time off.
" How do you know an air-traffic controller suffers from stress? His tackle box is missing.
" You know? He's gone fishing.
But I hate fishing.
Remember when I got that hook stuck in my finger? - Remember? It was a frog- - I got your medical records.
What? You didn't tell them Maggie was bipolar.
- You did what? What are you, the KGB? - Sergeant Eric Wyczenski.
- You called the MPs? - No.
- No.
- Why did you do this? You' re under arrest for unauthorized absence from the U.
S.
Air Force.
Somebody was supposed to cover for me.
He got in a bad accident.
I didn't find out until just now.
I'm headed back to base right now.
I came to tell my sister.
They looked for me and freaked her out.
It's been a huge mix-up.
- Abby, tell them.
- We'll figure that out on the way back.
That is unnecessary.
Let me get my stuff out of my car! - Stop! - Let me get my stuff! - Don't hurt him! - Listen, let me go.
I can explain everything, okay? Just- I need to go, seriously.
- I can't be arrested.
I've got a job! - Can we talk? Or let me give him something to calm him down.
- I'm afraid we can't do that.
- Is this what you wanted? Are you happy now? Yeah, that's right.
Lock me up and throw away the key.
Eric's been a bad boy! Thanks a lot, Abby! Thank you! - Suction.
Oh, damn it.
Bag him.
- Was he ever awake? For a few minutes.
He wasn't mentating well.
Stage-four shock, non-responder.
Both lungs are up.
Breath sounds with bagging.
Third unit of O-neg.
- You wanna try this? - You got it.
Stabilize the neck.
I'll do cricoid.
Damn.
Suction! He's so small.
Short chin, anterior too.
Not your lucky day, huh? - Sats, 88, pulse down to 90.
- You need help in here? - Nope.
- Yeah.
Suction.
We'll need another central line for pressors.
- What do you see? - I can't see squat! - Okay, let's take a break.
- No.
- Tube, now.
- Bradying down to 80.
Cords.
- Got it.
- Bag him.
Good job.
- All right.
You got this? - What? - Where are you going? - I have other patients.
- Susan, you' re not finished here.
- He's in good hands.
- What's happening? - He was on a vent, dropped his pressure.
- Give me a spinal needle.
- Lost the pulse.
Starting compressions.
- Betadine.
- Tamponade? Could be a tension pneumo.
Breath sounds could be transmitted.
- Sats are dropping.
- Could be hypovolemic.
Try the other side.
- No.
Milligram of epi.
- Good pulse with compressions.
- Thoracotomy tray.
- Holding CPR.
Looks like PEA.
Betadine the chest.
- Trendelenburg and roll him left side up.
- Blunt force trauma, Luka.
It's over.
Mediastinal air after intubation.
Blade.
No pressure, no pulse.
What is he doing? - Watch.
- Spreader.
Opening the chest cavity.
Pericardium looks clear.
Quiet.
Okay, bag him a couple of times fast.
- You hear it? - Hilar leak.
Clamp.
Bag.
- How long? - Almost a minute.
Again.
Got it.
Cross clamp.
Get me a 50cc syringe with an 18-gauge needle.
Okay, pressure's going up.
Fifties.
Evacuating the air.
That's why he couldn't pump blood.
Weak pulse.
Got a pulse.
So you can stay here.
You can be safe here.
Can you explain the concept of a women's shelter? What is she so afraid of? Living in poverty, deportation.
Take your pick.
It's called "trafficking in persons.
" Young women are brought over from some foreign country.
They get offered jobs and wind up as indentured servants.
I can't leave my baby.
You don't have to.
This is your baby.
Nobody's gonna take your baby.
Not this baby.
Aidan.
The 3-year-old? Is Aidan your son too? Yes.
Okay, Kit, let's try a t-piece trial.
Normally, we would have extubated in the OR, right? Normally.
No chest-wall excursions.
Sats are going down to 89.
Why isn't he breathing on his own? AC of 14.
- I'll go talk with the family.
- No.
I'm afraid I get to do that.
I knew something was wrong.
I knew it.
I told you.
- It's gonna be okay.
- No, it's not.
Don't say that.
He's sick.
I don't know where they took him.
It's not like the police.
I can't go there and bail him out.
I don't even know who to call.
- What if they put him in a VA loony bin? - That's not gonna happen.
- How do you know? - Because we'll get him a good lawyer.
And we'll help him through this.
Go home.
I'll get someone to cover your shift.
- I can't.
- Go home.
Get some rest.
Call me if you need me.
- Hey.
I thought you'd left.
- How's that kid? He had a hilar leak.
Kovac had to crack his chest.
Pedes surg is with him now.
It looks like he's gonna pull through.
- You would have done the same.
- Kerry, I killed three patients today.
It would have been four if I'd stayed.
No.
You were unable to save three patients.
You didn't kill them.
I mean, I've seen you save twice that many without breaking a sweat.
Go home.
Have a drink, maybe two.
Tomorrow's another day.
But if you lose more than one patient, you' re fired.
- Thanks.
- Hey.
- Hello.
How are you? - Good.
- Did you? - No.
- Are you going to? - No.
You can.
No.
You should.
- Come on.
- Okay.
Susan, we're gonna have a baby.
- What? You're pregnant? - No! I am.
Oh, my God! Kerry, congratulations! Thank you.
Thank you so much.
- Where are you going? - She's going home.
I'm not talking to you.
This is between me and my patient.
- She signed out against medical advice.
- Call the police.
Don't bother.
She won't press charges.
We have laws against slavery in this country.
Tong-yi, you don't have to do this.
I'll bring the car around.
All right, don't do this, Tong-yi.
It's wrong.
It's wrong.
I need my job.
I have family in China and they need my money.
- We can help you find another job.
- I can't leave my babies.
If you go back there, they' re gonna take your baby, just like with Aidan.
- I spend more time with him than they do.
- You should.
He's your son.
Does he even know that you' re his mother? He doesn't.
But I do.
- How's Mr.
Seaton? - He's still on a vent.
When you first came to me you requested I treat you like any medical student on my rotation.
And I appreciate it.
Your disease presents you with innumerable challenges.
And the fact that you' re standing here is testimony to your character.
But the truth is, I would fail any other student with a similar performance.
I have to make certain adjustments to accommodate my disease.
No.
No.
Political correctness aside, you are physically handicapped and I would be doing a disservice to your future patients.
So that's it? What's the appeal process? A promise.
I will pass you if you do not practice clinical medicine.
You can do Radiology, Psychiatry but you must give me your word that you will never treat patients.
No.
- I can't do that.
- Then you will fail, Mr.
Nathan.
- Is someone sitting here? - No, no.
- You look like you had one of those days.
- Yeah, you could say that.
What do you do? - I'm a jockey.
- He has a sense of humor.
Not really.
- It's pretty dead in here tonight.
- That's the way I like it.
I don't believe that for a second.
You look like you know how to have fun.
- Think so? - Yeah.
Excuse me.
- Hello? - Luka, I have to talk to you.
I can't talk to you right now.
Yes, he came to see me.
I think you need to stop calling me, okay? Sorry about that.
Why don't we get out of here and see what kind of trouble we can get into.
Where would we go? I'll leave that up to you.
Okay.
I think I know a place.
It's 300 an hour, 2000 for the night.
You coming? - I've been calling you.
- I was on the phone.
Did you reach him? You might have to wait till morning.
But I got some fish and chips from Brennan's.
I'm not hungry.
I bought it on the way home from work.
It took an hour to get it out of the bag and 45 minutes to put it in the glass and I still haven't had a sip.
I just wanted everything to stop, you know? - I just wanted to stop thinking about- - Hey, hey, hey.
I'm so glad you' re home.
I'm sorry.
I'm so sorry.
I wanted you to be wrong.
For both of you.
My family's so screwed up.
If I were you, I would run for my life and never look back.
You don't hold the monopoly on screwed-up families.
You met my mother.
She's not certifiable.
I have an idea.
We should get them all together for the holidays.
Gamma, my parents, your mother.
- I'm really scared for him, Carter.
- I know.
And it's so unfair.
Because he was such a good kid.
We went through so much growing up, and I really thought I got him through.
I thought he was safe.
He'll get all the help that he needs now.
We' re gonna make sure that he does.
And nothing that you did or didn't do would have prevented this.
It's just that Eric he was the only constant thing in my life, you know? He was the only thing I could ever really count on.
That's not true anymore.
Promise? Because I really need something to hang onto right now.
I'm not going anywhere.
R.
Congratulations, Mr.
Nathan, youre on call tomorrow night.
Thirty-two hours straight.
Labs on your baby.
You two need to figure this out.
- I was gonna call first, but Jody got sick.
- Who's Jody? You show up with this girl who's barely out of her teens.
- Aren't you due back at the base? - Not for a couple weeks.
A couple weeks? There it is.
I can see his heartbeat.
You can tell it's a boy? Because I can't.
No, it's just a figure of speech.
Just a pronoun.
Are you hoping for a boy? Not particularly.
I mean, a boy would be nice but I don't care.
I don't even really wanna know.
As long as it's healthy, right? - The rash of Lyme disease is? - Erythema migrans.
- Starts two to 20 days after the tick bite.
- Occurs in 60 to 80 percent of cases.
- The hallmark of the rash is? - Erythematous plaque.
Yeah.
And the most common neurological symptoms? - Facial nerve palsy.
- Facial nerve palsy.
Okay.
All right.
Settle down.
This is a teaching hospital, not medical Jeopardy! - Where are all the doctors? - Who? Anyone.
Carter, Weaver, Pratt, I'm not picky.
Carter's stuck in Triage.
Pratt's on at midnight.
- And Weaver's MIA.
- What else is new? - Kovac is sleeping.
- With who? I thought he's suspended.
He's back.
In the lounge.
Harkins, wanna try casting a Colles' fracture on a cranky old lady? Sure.
- What's the antibiotic of choice? - Doxycycline! Beth, this is Erin.
She's gonna be putting your cast on.
Beth? Miss Garrison? - I can't feel a pulse.
- Oh, jeez! She's cold.
- She's dead? - Bag her on 15 liters.
I need a crash cart in here! - Sister Beth? - She was a nun? - She is.
- Oh, boy.
Nathan.
Nathan, let's shake a leg.
Come on.
Corday's looking for you, man.
Be right there.
ER, please hold.
Think you could take this somewhere else? - I need to use the computer.
- Use one over there.
I don't want you near me when God strikes you dead for killing that nun.
- I didn't kill her.
- You didn't save her.
She was an 87-year-old woman in poor health.
What, you only save the healthy ones? She stroked out.
No one could foresee that.
You don't have to explain to me.
I'm not the one doing the judging.
- GSW, 10 minutes out.
- I'll be right there.
Is Dr.
Corday still down here? John Doe.
Found in the park.
No signs of serious trauma.
Promise me you won't let them near my face.
Sir, what's your name? - They dropped right out of the trees- - We got good breath sounds.
- Nobody's near your face, sir.
- No, don't let them near me! Settle down! Okay, get five of Haldol- - Don't let them bite me! - Relax, sir.
- No, no.
We're trying to help you.
- Get Security! - It's the dyskinesia.
- Still need the Haldol? Yes.
We got it.
We're going to need a head CT.
- You okay? - Yeah.
I'm fine.
Thanks.
Are you okay? Nothing that 12 hours of sleep wouldn't cure.
Put him on pulse ox, two liters O-2 by nasal cannula.
Mineral oil on a cotton ball should act as a solvent.
Come on in.
Let's get him inside.
Make sure his nasal passages stay clear.
Hey, Jody.
What are you doing here? I'm looking for Eric.
Abby.
- Hi, Abby.
- Hey.
What's going on? - Where's Eric? - I was hoping you knew.
What do you mean? I don't know.
We were in Indiana on our way back from my parents' - - They had a fight.
- It was hardly an argument.
He got really angry.
I was just asking him about us, our future, stuff like that and he took off.
I didn't mean to upset him.
- Maybe he went back to his base.
- No, I called.
They said he's been UA for two weeks.
- UA? - Unauthorized absence.
Abby? - He's AWOL? - Yep.
Joel Seaton, 67, syncopal episode at Navy Pier.
Paramedics found him dehydrated, systolic of 90.
Came up with 500 of saline.
Joel was diagnosed with pancreatic cancer three months ago.
What treatment have you been on, Mr.
Seaton? Megace and Gemzol.
They said I might have a year with the chemo, but I'm not doing too good.
He's had two stents in his common bile duct to relieve the obstruction.
It's probably clogged, which explains the fever.
- How's your pain? - Every night I go to bed I keep hoping I'll wake up in the morning and I'll be better and the pain will be gone.
Think there's a surgical alternative that could help? I'm afraid not.
What happens if you don't do anything? You'll get more jaundiced, slip into a coma from liver failure.
Your kidneys will fail and your heart will stop from a high potassium level.
Is that a painful way to die? Not once you slip into the coma.
We can arrange for home hospice care.
A nurse will visit you twice a day to give you the pain medications.
When my wife was living, she used to always say I'd probably die in my Barcalounger watching the football game.
I'm starting to think that's not such a bad way to go.
Does that mean youre no longer interested in further treatment, Mr.
Seaton? Sorry.
Let's have Ativan now.
- I can't see.
I can't see.
- All right, just relax.
Need some flush? Did you try to kill yourself, Greg? No.
It was an accident.
He didn't mean it.
Page ENT and Ophtho.
Get a Wood's lamp and fluorescein.
- Who, Greg? Who shot you? - Tommy.
- Ativan's onboard.
- A friend? He's my brother.
He's 10.
Need a two view of the face along with a trauma panel.
Look at this light, Greg.
- Can you see this light? - A little.
- Where'd Tommy get the gun? - He was playing with our dad's gun.
I tried to take it away from him so he wouldn't hurt himself, but it went off.
We'll do everything we can to make you comfortable.
Thank you.
Let me know if there's anything else you need, okay? Thank you.
- We should have pursued other options.
- What? With Corday.
There are treatments to consider.
I asked for surgical consult.
She didn't think it was a good idea.
What if it's in the patient's best interest? You went up against Carter on a terminal patient.
That's not your job.
- You're a med student.
- This guy could just be having a bad day.
We try to do what's best for the patient and respect their wishes.
If were lucky, we get to do both.
This is one of those times.
Have Pedes page me and get me that Ophtho consult.
Dr.
Kovac.
Mike Dobbs.
I think you know my wife, Heather.
Look, we've been having some rough times recently but I'd appreciate it if you'd stop seeing her.
- You should speak to your wife about it.
- Yeah, I did.
Are you married? I was.
Then you know how hard it can be.
Look, I'm not trying to threaten you or anything, man, but I got two daughters.
What do I tell them when their mother doesn't come home at night? I don't know.
Just trying to keep my family together, that's all.
Hey, Eric, it's me again.
Listen, could you please call me back? You don't have to talk to me.
Just leave a message on my machine, I'd appreciate it.
Thank you.
Looks like your day's sucking as bad as mine.
Yeah.
I'm worried about my brother.
I can't get in touch with him.
At least you haven't killed anyone.
I'm 0 for 2.
All these patients could be my next victim.
I think I have the crabs and it itches bad.
" - So youre not taking the chest pain in 4? - Not if he wants to live.
Guy in Exam 2 with scrotal swelling.
Pretty safe bet.
- I'm not that desperate.
- At least it's medical.
- He's pushing 300 pounds! - It's a big scrotum.
He's a heart attack waiting to happen.
Half these patients are.
Old, diabetic, old, old and diabetic.
- Did you reach him yet? - No, I get his voice mail.
Oh, screw it.
Give me the swollen scrotum.
Maybe he's off with a buddy or something.
Dr.
Carter, could you reassess my allergic reaction in 2? - I'll be right there.
- Where's Jody? She's checking into a hotel.
- Wanna get coffee? - He didn't respond to Benadryl.
- Try Solu-Medrol.
- I did.
He's still wheezing.
- Try an albuterol treatment.
- It didn't work.
Should I push an IV epi? - I'll be right back.
What are his sats? - Eighty-three on oxygen.
- Why didn't you come get me? - I just did.
- Base operations.
- Medical facility, please.
One moment.
Medical.
I'm from Chicago's County General Emergency Department.
Were treating a patient from your base, Eric Wyczenski.
Were gonna need his medical records faxed over.
- Yes, ma'am.
Who's his doctor? - I don't have the chart in front of me.
- Does it matter who the doctor is? - Yes.
- We can't release his records otherwise.
- Okay, just a second.
The physician's name is Dr.
John Carter.
Dr.
John Carter.
Thank you, ma'am.
- Excuse me.
- It's okay.
How are you feeling, Greg? My eyes hurt.
Can you see anything? No.
Hey, Chuny? - Yeah? - I'm sorry.
About everything.
Me too.
Am I blind? You have a shotgun pellet inside your eyeball.
Were bringing in an eye specialist to repair it.
Youre lucky.
You could've blown your head off.
My dad would be less mad at me if I was dead.
He shouldn't be angry with you at all.
You probably saved your brother's life.
- Hey, can I talk to you for a second? - Shoot.
Carter! Carter! - Is there anything wrong with him? - Not that I can tell.
Neighbor heard the baby crying.
Found Mom in the backyard, kid in the swing.
Mom's got no sign of trauma.
Could be a possible mixed OD.
GCS, 415, but she's uncooperative.
- BP, 122/78.
Pulse, 84.
- Okay.
What's her name? Neighbor wasn't sure, thought it was Tenji or Tong-yi.
- She didn't have ID.
- Ma'am, can you tell me your name? I have a 16-year-old boy who's gonna go blind if he doesn't get here fast.
Tell me where he is so I can call for some initial orders.
- He's on the golf course.
- He's where? He's playing golf at the country club.
Eyes open to painful stimuli.
- Is your name Tenji? Or Tong-yi? - Is she oriented to person? - Her little boy's fine.
- Does she understand English? Gag reflex is present.
I smell alcohol on her breath.
- Got your bloods.
- Okay, what do you want? - CBC, lytes, ET OH.
- Aspirin and acetaminophen levels.
Hello? Eric! - What about charcoal? - Where are you? The 2001 recommendations from Clinical Toxicology - didn't support the administration - I need to talk to you.
- She can't tell us when she took it.
- Twenty-five of charcoal.
I need some Surgilube and an NG tube.
Abby, she needs a Foley, tox screen.
- Damn it.
- And let's change the saline to D-five - half at 75 an hour.
- Hello? Blunted deep tendon reflexes.
Could be benzos.
- Should we try Flumazenil? - Only if you want her to start seizing.
- Did you lose him? - Yeah.
I lost him.
It's not unusual to experience these feelings when dealing with chronic illness.
Mr.
Nathan, may I have a word? Excuse me.
- What's he doing in there? - That's Dr.
Harvey.
- He's the Attending psych- - I know.
I asked you what he's doing.
He was on a psych consult on another patient and I asked if he would speak with Mr.
Seaton.
- Did you run this by Dr.
Lewis? - No.
Dr.
Harvey agreed.
Mr.
Seaton was depressed and wasn't objective about his own treatment.
- He's refused treatment.
- He's willing to consider other options.
- A Whipple, for instance- - A Whipple? No.
Please don't tell me you suggested a Whipple for this patient.
I'm not sure who brought it up.
Well, whoever did must be utterly insane because nobody in their right mind would suggest a 6-hour operation.
An operation that requires months of recovery, assuming he ever recovers.
- And for what? - He's dead in 2 months if we do nothing.
That's right.
But only you seem to be unwilling to accept that.
Well, shouldn't we at least present him with all the facts and let him decide? You've done enough, thank you.
Normal vitals, satting well on room air.
- You get your phone working? - No.
Tox screen is positive for barbiturates.
Blood alcohol level's only.
065.
Urine dip's negative, but ICON's positive.
She's coming around.
Ma'am? Do you know that you' re pregnant? You speak English? Where's Chen? Maybe she can translate for us.
I wanna rule out an ectopic.
Where is the portable ultrasound? - I'll get it.
Can I do it? - Yeah.
I'll be right back.
I'm sorry, but it was right in the middle of a trauma.
Maybe he'll call back.
- Check your home machine? - No.
I didn't have a chance to.
Well, how did he sound? Depends on who you ask.
Sounds great.
He's happy, he's carefree, he's having the time of his life.
Just the fact that he called is a pretty good sign.
Yeah, he's manic, Carter.
Say, Abby, here's two of the country's finest looking for a patient.
I'm Sergeant Andrews with the Air Force Office of Special Investigation.
I understand you' re treating Eric Wyczenski.
No.
We were, but we' re not now.
He left against medical advice.
Any idea where he may be going? I'm sorry we can't be more helpful, but we have an emergency.
- What about the doctor who treated him? - He's upstairs.
If you leave your card, we'll call you if he shows up again.
- What was that all about? - I was about to tell you.
These are your brother's medical records? I said we were treating him.
You'd still require his signature.
And a written request from his Attending physician which in this case was You forged my name too? - We could get into trouble for this.
- Just read it.
No.
I have no right to read this, and neither do you.
He took a leave of absence for stress following a near-miss incident.
Yeah, so? He's an air-traffic controller.
- It's a stressful job.
- He had therapy but wasn't medicated.
Probably no reason to.
Just a reaction to the event.
What if it isn't PTSD? What if it was depression? The initial presentation of a bipolar disorder? - He's too old.
- He's under 30.
Well, then he'd be at the far end of the curve.
He's been suffering from insomnia, lack of appetite.
- Both of which are consistent with PTSD.
- Six months ago he was depressed.
Now he's cycling up to a manic phase.
The timing is perfect.
I know.
- Why didn't the Air Force catch it? - They' re not looking for it.
Look.
"No family history of psychiatric disorders.
"He's lying to the doctors.
Just like you did to get those records.
- I thought this was a surgical consult.
- It was.
- What happened? - Fat lady sang.
Fat man, in this case.
We did everything but order him a deep-dish pizza.
Yeah.
Just say no to drugs and double bacon cheeseburgers.
His size is probably something that he couldn't control.
Certainly not if he was running downhill.
- Nathan, we didn't mean to offend you.
- You didn't.
- I'm sorry.
I'm having a really bad day.
- Not as bad as him.
- What the hell is that? - I don't know.
- You can't drive on here, you idiot.
- Which one of you is Dr.
Abrams? - I'm Abrams.
- You need to come with me now.
I've got a 14-year-old boy with a ruptured globe.
He may lose his eyesight because you didn't answer your page.
You' re insane.
- Get in the car.
- Get out of here.
- Get in the car now! - You don't have to listen to this guy, Vic.
- Are you a doctor? - An oral surgeon.
- Then shut up.
Let's go! - What about my clubs? You, take his clubs.
You' re doing a good job clearing the patients.
Easy to be fast when you' re just killing them.
- I'm gonna be taking some time off.
- Yeah? For what? Just to deal with some personal things I've been putting off for a while.
With Romano out of commission you'll probably be the one forced to pick up the slack.
Bad idea.
Do you mind? We' re having a conversation here.
- I don't mind.
- Well, I do.
I mind.
I mind your insinuations and your smart-ass comments.
This is an ER.
People come here because it's an emergency.
Guess what.
Some of these people are gonna die.
I've saved hundreds of lives.
- Dr.
Lewis.
- Yeah.
You know that drunk you intubated this morning? - He asked to take his tube out.
- He can't talk if he's intubated.
I think you better come.
He's gonna vomit and aspirate.
Twenty bucks says she kills this guy too.
- Frank, did my brother call? - Nope.
- Are you sure? - Let me double-check.
Nope.
Hey, Abby.
Tell Abby what you just told me.
An unauthorized absence can be a serious offense.
But if it's a first offense and you can prove extenuating circumstances you can get off with minimum punishment.
That's good to know.
Thanks.
- Do you have a minute? - Yeah.
Thanks.
Your girlfriend, Harkins, was looking for you.
Why are you talking about my brother to med students? Gallant's in the Army.
I'm trying to get information.
You didn't have to say it was my brother.
Excuse me, Carter.
This is Mr.
and Mrs.
Yeung.
Their child was brought in.
- Which one? - The 3-year-old with your patient.
Oh, I'm sorry.
I thought she was the mother.
No.
Tong-yi's our nanny.
I'm Aidan's mother.
- Is our son okay? - Yeah, he's fine.
Chuny, you can take Mrs.
Yeung to see her son.
Sir, if I can just ask you a couple questions first? Yeah.
Okay.
- Is Tong-yi a drug user? - No.
- Has she been depressed? - No.
Can you think of any reason why she would hurt herself? She wouldn't do that.
She tested positive for barbiturates and alcohol.
Well, she's been up all week with Aidan.
He had an earache.
She might've taken some sleeping pills, maybe a glass of wine but she's not suicidal.
Does she have a boyfriend? I don't think so.
- Why? - I just- I don't know.
Maybe she's got some problems in her personal life.
Well, if she did, we'd probably know.
She lives with us, has been for four years now.
Can I see her? - You wanted to see me? - Did you review Zollinger? - Was I supposed to? - He's under.
- Thanks, Shirley.
- Are we gonna do a Whipple on him? - He's a little old.
- Thought you didn't wanna do this.
I didn't, but thanks to you he and his family seem to think the operation is worth the risk.
They may have second thoughts after we resect his pancreas duodenum, gall bladder and a portion of his stomach.
He's got a daughter and grandchildren.
Any extra time he gets, he could spend with them.
- He could get up to a year from this.
- Perhaps.
If it comes with a small miracle.
Which may be in order seeing as you seem to have become the patron saint of the terminally ill.
You prepared to assist? - Really? - You got us into this.
We' re still running some tests.
Okay.
Sonosite is ready.
I need both trauma rooms.
Double MVA en route.
Auto versus motorcycle.
- Can I take these two? - Yeah.
Grab trauma gowns and gloves.
Come on.
- Can we take her home? - She should stay for observation.
In that case, I'd like to have her moved to a private facility.
Would you ask her why she did it? She's not depressed.
It was an accident.
She took a couple of sleeping pills with a glass of wine to help her sleep.
And she's sorry to have caused you any trouble.
- She said all that? - Yes.
Suction here so I can see the field.
Are you okay? I've been up for 24 hours.
It throws off my meds.
Does it usually bleed this much? There are numerous branches off the superior mesenteric artery.
Hemostat.
Do we tie off or bovie? Pressure's down to 90/60.
Okay.
Bolus a liter and check a crit.
Like this? You need to isolate the source of the bleeding.
Come on, Nathan.
I need better exposure.
Stop! Stop! You' re up against the portal vein.
Pull out before you tear the wall and kill him.
- Shirley, take over, please.
- Just tell me what to do.
I'm trying.
Shirley, suction.
- What was that? - T-tube for the common bile duct.
- Do we have another tray? - We can autoclave this one.
I don't have 30 minutes to wait for this.
- Tell me what you want me to do.
- Nothing.
Shirley, pick up the instruments, get them re-sterilized.
This will pass in about an hour.
Carl Vanosh, 32, motorcycle driver versus stakebed truck.
Extracted.
- Unable to breathe for four minutes.
- Violaceous discoloration.
Classic traumatic asphyxia.
Get an ABG and full trauma panel.
I'll meet you inside.
- This the driver of the truck? - Motorcycle passenger.
Quinn Vanosh, 11.
BP falling after two liters Nobody told me they were bringing in a kid.
He's tachy to the mid-120s.
We were gonna tube him.
Go get one of the Attendings.
Anyone.
Who's that? - I thought you were treating her.
- I am.
Dr.
Chen is translating for me.
- I should be doing that.
- That's okay.
We' re a full-service facility.
- She didn't know she was pregnant.
- Did she say who the father is? No.
- Ask her if she's sleeping with her boss.
- What? Ask her if she's sleeping with him.
CBC and lytes, crit times three, Chem-7, urine and Foley.
- He's got Tardieu's spots.
- Tardieu? - Facial petechiae.
What fell on him? - A truck.
Crepitus over left chest, tender pelvis.
- Sats, 93.
- It hurts to breathe.
- Kerry, I need help in here.
- Quinn? What's wrong? Left breath decreased with right tracheal shift.
- Sux and Fent are in.
Sats are still 90.
- Needs a central line and a chest tube.
You' re doing fine, Susan.
Just take a deep breath.
Decreased on the right as well.
He's got tension pneumos.
- What's wrong with my son? - We' re working on him.
Malik.
- What do you want me to do? - Bag him up.
- Ectopy.
- Don't do this to me, kid.
Your wife seems upset.
She's worrying about Aidan and Tong-yi, that's all.
Well, our doctor's coming to move her to another facility.
What was your relationship with Tong-yi again? I told you, she works for us.
Right.
She's lived with you for four years? Have you been sleeping with her? Have you been having sex with her? Because she's pregnant and she says the baby's yours.
Even if that were true, doctor, it's none of your business.
No, it is.
It was my business the minute she became my patient.
She won't be your patient much longer.
Hey, Carter! Eric, where have you been? Everybody's been worried about you.
- Come inside.
- Oh, Jody was driving me nuts! Nothing like a road trip to bring out a person's issues.
" Please limit your baggage to two items.
" She must've peed 1000 times between here and Indianapolis.
She's worse than a beagle.
Probably got a bladder thing.
- Wait.
I thought you guys flew.
- We were.
Until she got airsick.
Airsick, carsick, homesick.
The girl gets sick a lot.
Which supposedly runs in her family.
Don't get me started on her parents.
If she turns out to be anything like her mother she's gonna be too much woman for me to handle.
She's big.
Like sumo big, minus the agility.
- I'll come later to see how you're doing.
- Will you talk to my dad? I'll do even better.
I'll convince him you're a hero.
- The in-house team could have done this.
- You' re the retinal specialist.
According to the CT, the other eye has a pellet in it too.
I can't promise I'll be able to save his sight in that eye.
- Perhaps if you'd have come here sooner.
- Ophthalmology isn't emergency medicine.
You know, some guys wait a week to do this kind of surgery.
You know, all you did was stop me from shooting an 82.
Tell it to him.
- Luka, Dr.
Lewis needs you in Trauma 1.
- Oh, thanks.
So I'm in a position where I can buy the Cessna or two planes that need some fixing up for the same price.
- I've been calling you.
- So I hear.
I'm sorry Jody dragged you into this.
She's immature.
She likes the drama.
It's the Jerry Springer generation, you know? You were supposed to be at your base two weeks ago.
- Did they call here? - No.
That's the second time this year somebody's messed up my leave.
I'll have to report for duty on Monday.
We should do something crazy! Wanna go somewhere? How about you, me and Carter fly to Vegas.
We could do a little gambling, maybe hit an Elvis wedding chapel.
"You may now kiss the bride.
Thank you very-" Just come here.
Just stop it.
They said you' re suffering from post-traumatic stress? It was nothing.
They cleared me.
Every controller's had a couple PTSD assessments.
It's our way of working the system to get time off.
" How do you know an air-traffic controller suffers from stress? His tackle box is missing.
" You know? He's gone fishing.
But I hate fishing.
Remember when I got that hook stuck in my finger? - Remember? It was a frog- - I got your medical records.
What? You didn't tell them Maggie was bipolar.
- You did what? What are you, the KGB? - Sergeant Eric Wyczenski.
- You called the MPs? - No.
- No.
- Why did you do this? You' re under arrest for unauthorized absence from the U.
S.
Air Force.
Somebody was supposed to cover for me.
He got in a bad accident.
I didn't find out until just now.
I'm headed back to base right now.
I came to tell my sister.
They looked for me and freaked her out.
It's been a huge mix-up.
- Abby, tell them.
- We'll figure that out on the way back.
That is unnecessary.
Let me get my stuff out of my car! - Stop! - Let me get my stuff! - Don't hurt him! - Listen, let me go.
I can explain everything, okay? Just- I need to go, seriously.
- I can't be arrested.
I've got a job! - Can we talk? Or let me give him something to calm him down.
- I'm afraid we can't do that.
- Is this what you wanted? Are you happy now? Yeah, that's right.
Lock me up and throw away the key.
Eric's been a bad boy! Thanks a lot, Abby! Thank you! - Suction.
Oh, damn it.
Bag him.
- Was he ever awake? For a few minutes.
He wasn't mentating well.
Stage-four shock, non-responder.
Both lungs are up.
Breath sounds with bagging.
Third unit of O-neg.
- You wanna try this? - You got it.
Stabilize the neck.
I'll do cricoid.
Damn.
Suction! He's so small.
Short chin, anterior too.
Not your lucky day, huh? - Sats, 88, pulse down to 90.
- You need help in here? - Nope.
- Yeah.
Suction.
We'll need another central line for pressors.
- What do you see? - I can't see squat! - Okay, let's take a break.
- No.
- Tube, now.
- Bradying down to 80.
Cords.
- Got it.
- Bag him.
Good job.
- All right.
You got this? - What? - Where are you going? - I have other patients.
- Susan, you' re not finished here.
- He's in good hands.
- What's happening? - He was on a vent, dropped his pressure.
- Give me a spinal needle.
- Lost the pulse.
Starting compressions.
- Betadine.
- Tamponade? Could be a tension pneumo.
Breath sounds could be transmitted.
- Sats are dropping.
- Could be hypovolemic.
Try the other side.
- No.
Milligram of epi.
- Good pulse with compressions.
- Thoracotomy tray.
- Holding CPR.
Looks like PEA.
Betadine the chest.
- Trendelenburg and roll him left side up.
- Blunt force trauma, Luka.
It's over.
Mediastinal air after intubation.
Blade.
No pressure, no pulse.
What is he doing? - Watch.
- Spreader.
Opening the chest cavity.
Pericardium looks clear.
Quiet.
Okay, bag him a couple of times fast.
- You hear it? - Hilar leak.
Clamp.
Bag.
- How long? - Almost a minute.
Again.
Got it.
Cross clamp.
Get me a 50cc syringe with an 18-gauge needle.
Okay, pressure's going up.
Fifties.
Evacuating the air.
That's why he couldn't pump blood.
Weak pulse.
Got a pulse.
So you can stay here.
You can be safe here.
Can you explain the concept of a women's shelter? What is she so afraid of? Living in poverty, deportation.
Take your pick.
It's called "trafficking in persons.
" Young women are brought over from some foreign country.
They get offered jobs and wind up as indentured servants.
I can't leave my baby.
You don't have to.
This is your baby.
Nobody's gonna take your baby.
Not this baby.
Aidan.
The 3-year-old? Is Aidan your son too? Yes.
Okay, Kit, let's try a t-piece trial.
Normally, we would have extubated in the OR, right? Normally.
No chest-wall excursions.
Sats are going down to 89.
Why isn't he breathing on his own? AC of 14.
- I'll go talk with the family.
- No.
I'm afraid I get to do that.
I knew something was wrong.
I knew it.
I told you.
- It's gonna be okay.
- No, it's not.
Don't say that.
He's sick.
I don't know where they took him.
It's not like the police.
I can't go there and bail him out.
I don't even know who to call.
- What if they put him in a VA loony bin? - That's not gonna happen.
- How do you know? - Because we'll get him a good lawyer.
And we'll help him through this.
Go home.
I'll get someone to cover your shift.
- I can't.
- Go home.
Get some rest.
Call me if you need me.
- Hey.
I thought you'd left.
- How's that kid? He had a hilar leak.
Kovac had to crack his chest.
Pedes surg is with him now.
It looks like he's gonna pull through.
- You would have done the same.
- Kerry, I killed three patients today.
It would have been four if I'd stayed.
No.
You were unable to save three patients.
You didn't kill them.
I mean, I've seen you save twice that many without breaking a sweat.
Go home.
Have a drink, maybe two.
Tomorrow's another day.
But if you lose more than one patient, you' re fired.
- Thanks.
- Hey.
- Hello.
How are you? - Good.
- Did you? - No.
- Are you going to? - No.
You can.
No.
You should.
- Come on.
- Okay.
Susan, we're gonna have a baby.
- What? You're pregnant? - No! I am.
Oh, my God! Kerry, congratulations! Thank you.
Thank you so much.
- Where are you going? - She's going home.
I'm not talking to you.
This is between me and my patient.
- She signed out against medical advice.
- Call the police.
Don't bother.
She won't press charges.
We have laws against slavery in this country.
Tong-yi, you don't have to do this.
I'll bring the car around.
All right, don't do this, Tong-yi.
It's wrong.
It's wrong.
I need my job.
I have family in China and they need my money.
- We can help you find another job.
- I can't leave my babies.
If you go back there, they' re gonna take your baby, just like with Aidan.
- I spend more time with him than they do.
- You should.
He's your son.
Does he even know that you' re his mother? He doesn't.
But I do.
- How's Mr.
Seaton? - He's still on a vent.
When you first came to me you requested I treat you like any medical student on my rotation.
And I appreciate it.
Your disease presents you with innumerable challenges.
And the fact that you' re standing here is testimony to your character.
But the truth is, I would fail any other student with a similar performance.
I have to make certain adjustments to accommodate my disease.
No.
No.
Political correctness aside, you are physically handicapped and I would be doing a disservice to your future patients.
So that's it? What's the appeal process? A promise.
I will pass you if you do not practice clinical medicine.
You can do Radiology, Psychiatry but you must give me your word that you will never treat patients.
No.
- I can't do that.
- Then you will fail, Mr.
Nathan.
- Is someone sitting here? - No, no.
- You look like you had one of those days.
- Yeah, you could say that.
What do you do? - I'm a jockey.
- He has a sense of humor.
Not really.
- It's pretty dead in here tonight.
- That's the way I like it.
I don't believe that for a second.
You look like you know how to have fun.
- Think so? - Yeah.
Excuse me.
- Hello? - Luka, I have to talk to you.
I can't talk to you right now.
Yes, he came to see me.
I think you need to stop calling me, okay? Sorry about that.
Why don't we get out of here and see what kind of trouble we can get into.
Where would we go? I'll leave that up to you.
Okay.
I think I know a place.
It's 300 an hour, 2000 for the night.
You coming? - I've been calling you.
- I was on the phone.
Did you reach him? You might have to wait till morning.
But I got some fish and chips from Brennan's.
I'm not hungry.
I bought it on the way home from work.
It took an hour to get it out of the bag and 45 minutes to put it in the glass and I still haven't had a sip.
I just wanted everything to stop, you know? - I just wanted to stop thinking about- - Hey, hey, hey.
I'm so glad you' re home.
I'm sorry.
I'm so sorry.
I wanted you to be wrong.
For both of you.
My family's so screwed up.
If I were you, I would run for my life and never look back.
You don't hold the monopoly on screwed-up families.
You met my mother.
She's not certifiable.
I have an idea.
We should get them all together for the holidays.
Gamma, my parents, your mother.
- I'm really scared for him, Carter.
- I know.
And it's so unfair.
Because he was such a good kid.
We went through so much growing up, and I really thought I got him through.
I thought he was safe.
He'll get all the help that he needs now.
We' re gonna make sure that he does.
And nothing that you did or didn't do would have prevented this.
It's just that Eric he was the only constant thing in my life, you know? He was the only thing I could ever really count on.
That's not true anymore.
Promise? Because I really need something to hang onto right now.
I'm not going anywhere.