ER s09e08 Episode Script
First Snowfall
Previously on E.
R.
- What's the appeal process? - A promise.
You must give me your word that you will never treat patients.
- No.
- Then you will fail, Mr.
Nathan.
- You called the MPs? - No.
- Why did you do this? - Youre under arrest for unauthorized - absence from the U.
S.
Air Force.
- Wait; hold on a second, guys.
Lock me up and throw away the key.
Eric's been a bad boy! Thanks a lot, Abby! Thank you! It's Sergeant Eric Wyczenski.
Whiskey, Yankee, Charlie, Zulu, Echo, November, Sierra, Kilo, India.
- Wyczenski.
- Could you tell me his squadron number? Hold on.
Do you know his squadron number? I don't know.
I'm not sure.
You don't have a central directory? Johnny's up.
He pulled out his Hep-Lock.
Get Conni.
I'm off.
No, no.
I'm calling on behalf of a family member.
Okay.
Then can you transfer me to the confinement facility? - Stop staring! - They don't talk to family members.
- I'm not gonna lie.
- I just wanna know where he is! - Stop staring! - She offered her cat a teaspoon of acid.
- Get away, freak-o.
- Sine equals cosine- Hello? Lieutenant Michael Gallant, U.
S.
Army Reserve.
- What are you doing? - Are you deaf? I said, get away! - Stop it.
- He won't stop staring.
- He's not hurting anybody.
- He smells like piss, man.
- This way.
This way.
- Keep the mental cases locked up.
- It's irrational, but it has a fraction- - He's not at Great Lakes.
- I kept trying to call you.
- Couldn't get a phone signal on the base.
- Sit down.
- It's a rule.
It's a constant.
But they did keep Eric there on Thursday night.
- They told you that? - They held Eric there three nights ago - then transferred the next morning.
- Transferred him where? Nebraska, his base.
Might as well be Manila.
There's, like, 100 offices on that base.
Is that Army or Air Force? I was desperate.
I thought he could use military lingo or something.
Great, thanks.
Okay.
So they gave me the number to the 55th Wing Judge Advocate's Office.
I left five voice mails there.
They' re closed all weekend.
Did you get the name of his attorney? - I can call back.
- That's okay.
Thanks.
I'm just gonna go there.
I'm just gonna go there.
Okay.
Why don't I call the travel agent, see if we can book a flight out for tomorrow.
- I wanna go tonight.
- Confirm he's there.
I've been trying to confirm where he is for three and a half days.
- Is there a flight out tonight? - Yep.
United, 9:30 to Omaha.
My shift just started five minutes ago.
I can't dump it now.
- You don't have to come.
- You can't go by yourself.
- I usually do this by myself.
- Let me find Chen to cover for me.
She left five minutes ago.
Do you even know how to get onto a military base? - There must be a visitor's center.
- You have to have a sponsor.
- I'll figure it out.
- At least take Gallant with you.
- That's what I need, a med student.
- To us, he's a med student.
- To them, he's an officer.
- He has things to do.
He's been on a base before.
He speaks the lingo.
Can you call me a cab, please? Maybe some T-shirts.
They' re in the third drawer on the right from the bottom.
Just pick out anything that doesn't look like I slept in it.
What about toiletries? Toothbrush, toothpaste? I'll just buy that stuff when I get out there.
And socks and underwear in the second drawer.
Pull them from the top.
- Why? - Because those are my respectable- Oh, right, and - Were they open? - Yeah.
Just made it.
- What? - Dry cleaner.
- My uniform.
- Thought it might help.
- You don't have to do this, Gallant.
- Never been to Omaha.
What's that? Internal medicine exam next week.
Oh, that's great.
You coerced a med student into failing his rotation.
I'm on a 10:00 flight.
I get in at 11:30.
- Call me if you need anything.
- When are you gonna sleep? Just get in the cab.
Thank you.
I'll see you in Nebraska.
Okay, Frank, what do we got? Let's see.
Four-F with abdominal pain in Exam 3.
five hundred and 10, equals 284.
Jacob gave Esau 220 goats and 220 sheep.
Come on, Johnny.
Let's see if we can't get you something to eat.
Come on, foot.
Come on.
Come on.
You say delayed, but you mean canceled.
- No, sir - Well, how long does that usually take? - Go ahead.
- Can you give me any estimate? - Go ahead.
I got it.
- I could be here a while.
Go ahead.
Well, have they even started to plow the runways yet? No task on the agenda has priority over the number 200.
Sum of the main diagonal should be equal to the sum of each row.
Now, that's tricky, but it's part of the magic.
Must be equal.
Must be all.
Sum of the major diagonal should be equal to each row and each column.
Now, that's more tricky, but it can be done if you know the secret.
Sum of three numbers geometrically equidistant from the center - You okay? - Yeah.
It's just worse when I wake up.
At least you got some sleep.
- Hey, did it stop snowing? - Yeah.
But don't expect to go anywhere.
- I got another 12 hours anyway.
- At least they'll be quiet.
- Hello? - John.
Hey.
Hang on.
- Hey, where are you? - Looking for Eric's commanding officer.
- You got on the base.
- Yeah.
You were right.
Gallant's a fast talker.
I'm looking at one of those stealth plane things right now.
- You see the news? - What? - I said, did you see the news last night? - No.
What happened? Three feet of snow dumped in seven hours.
Carter, I can't hear you.
Three feet of snow dumped in seven hours last night.
The airport's closed.
I'm at work.
I can't get my car out of the parking garage.
El's shut down.
The El.
Forget it.
Is he there? Eric.
Is he there? I don't know.
Nobody seems to know anything, actually.
I thought the military was supposed to excel in communications.
They had trouble giving direction on where to park much less You all right? - Yeah, I'm fine.
- Carter? No, no.
Not you.
- What? - Off the phone! You' re a civilian in a restricted area.
Get off the phone.
- I'll call back.
- Tell her to get off the phone.
Talk to you later.
Your office issued a visitor's pass and suggested we look for you in Hangar 12.
That, lieutenant, is Hangar 13.
- "Oh," what? - Oh, sir.
- Sir.
- You're Wyczenski's sister? - Yes.
- Funny guy.
Popular too.
Unfortunately, he didn't feel much responsibility to the Air Force.
Is he here? Because nobody's telling us anything.
Ma'am, I just came off of a 72-hour live-fire exercise short one air-traffic controller.
- If Sgt.
Wyczenski was apprehended- - Aren't you his commanding officer? If he was picked up in Chicago, he would be brought here.
Go to your hotel.
Leave your number with my office.
He's suffering from a psychiatric disorder.
I'm well aware of the " near-miss" depression.
Bipolar disease.
Manic depression.
He needs to see a psychiatrist.
He needs to be evaluated and medicated now.
So wherever he is, wherever you seem to have lost him, he needs help.
- snow day for all city offices and school - Did you hear that? - Closed.
City offices.
Read the sign.
We' re county.
They haven't plowed the bay.
They' re having trouble getting on the road.
Chuny, Lydia wants to know, since you' re stuck here, if you'll take her shift.
Tell her to break out the shovel.
Hey, repeat troponin's negative on 5.
Send him home with a sled and some Huskies.
- It is so quiet.
- I know.
Kind of freaky, huh? - So you trying to rent a snowmobile? - Considering it.
- Do they deliver? - I can't get them to answer the phone.
Rack is empty, Triage is clear and labs are pending on my only two patients.
- Good.
- So, what do I do now? I don't know.
Go play in the snow.
Hey, Ella! Please tell me daycare's open.
There's a kindergarten teacher in Exam 4.
My nanny couldn't get out of her front door.
- That's what windows are for.
- I'm soaked to my knees.
- All we did was walk from the El.
- The El's open? - I wouldn't do that if I were you.
- We're outside.
- On an Air Force base.
- Do you need clearance to smoke too? You can't talk on a cell phone.
You can't smoke.
You see that truck? - Yeah.
- That's jet fuel.
- Amy Lockhart? - Abby.
Lieutenant Ottenson, your brother's detailed counsel.
- Has he been charged with something? - No.
Not officially.
- Acting combative or argumentative? - I don't know.
- Delusional? - I haven't seen him.
I just got the jacket.
Can I go in there? I really need to talk to him.
- He's not here.
The judge advocate- - Wait a minute! Wait! His CO said that they took him to confinement Friday afternoon.
And transferred to base hospital Saturday morning.
Oh, my God! I'm so sorry.
I'm sorry.
- I thought you were Malik.
- Do I look like Malik? Sorry, man.
You ain't that good-looking.
- What are you doing? - You told me to play in the snow.
You can't let him outflank you like that.
Yeah, right.
- Commuting on skis.
- What? - You' re skiing to work.
- Yeah.
I don't live far.
- Nice coat.
- Goodwill box.
- Hey, did you find him? - Who? Abby's brother.
I'm gonna catch a train to Midway and wait for it to open up.
- Where are you going? - Nebraska.
She's already there.
She left last night.
- You didn't go with her? - I had a shift.
- I sent Gallant with her.
- Gallant? - Yeah.
Why? - Carter, we've got multiples coming in.
- Luka's here.
- Three criticals.
One adult, two kids.
Some drunk plowed through a family making a snowman in their front yard.
- Where's Weaver? - She can't get her car out.
The El's running.
It's hard walking through the snow with a cane.
She's disabled, remember? I thought we were closed to ambulance traffic.
How's anybody gonna get in? We'll do a hot unload.
Stay with me.
Approach the helicopter from the front.
It'll be windy as hell up there.
If anything blows away, don't chase it.
- It's far too easy to become disoriented.
- Right.
- You need some help? - I've got it.
Your stethoscope will be useless.
So will your ears, for that matter.
Rely on your other senses.
Look for chest excursion, feel the pulses, study the monitor.
Pulse ox, ECG, dynamap.
They'll tell you all you need to know about the status.
Don't even try to take a history until- You have a tremor on the left.
That's the Sinemet.
It works faster when I chew it.
I've only noticed it on the right.
Have you had symptoms on the left before? - Stress, you know.
Sleep deprivation.
- Or a progression of your disease.
My rotation's almost over.
Why do you do this to yourself? Working these insane hours when you- Please don't treat me like I'm dying, okay? Can we just go get this patient? Keep your head down.
Stick with me and stay clear of the tail rotor.
- They gave him a drug called "Depacot.
" - Depakote.
- And Zy- - Zyprexa.
Apparently, he's coherent.
He's scheduled to go up against a Rule 706 sanity board at 1200.
- "Up against"? - It's just a formality.
- If he was psychotic- - " Manic, " actually, is the term.
Manic.
Then they won't court martial.
They'd process him on medical discharge.
How long will they hold him? If he's mentally stable, they'll release him.
No one calls me to get a family history or gives me time to set up treatment for him? You'll just boot him out? If he'd asked for family, someone would have contacted you.
- He's not thinking clearly.
- Abby.
Hi.
Hi.
The doctor's in with him now.
- Name? - Mother's screaming for Toby and Matt.
- I don't know which is who.
- Toby.
The other one's Matt.
Cushing's response.
Vital signs negative.
No hemotympanum.
Pupils blown.
Seven mm bilaterally non-reactive.
No corneal or gag reflex.
His brain is mush.
- Tell me the drunk driver died on impact.
- It was one of those monster trucks.
- He hit the whole family? - Dad was getting a carrot for the nose.
- CT's ready.
- Scan the belly along with the head.
- I need to get to the other one.
- Epidural hematoma? - If we' re lucky.
- Set me up for a central line.
- Pulse ox is only 85.
- Is that the mother? - C-spine is clear.
- Jumped in front.
Truck hit straight on.
- Does your belly hurt, ma'am? - Chest.
Flail segment.
Thirty-two French.
Please.
My boys.
Please, save my boys.
Full trauma panel.
Type and cross for 4, portable chest and pelvis.
Another unit on the second line.
Let's set up for a femoral.
- We have blood? - We'd better.
He's got contusions and crepitus over the left chest.
- They left my mom.
- No, they didn't.
- They left her in the snow.
- Follow this light with your eyes.
- She's here.
We' re helping her.
- Where's Toby? He's here too.
Decreased on both sides.
Bilateral thoracostomy.
- Ten blade.
- Times two.
Pressure's holding, but he's tachy.
All his ribs are shattered.
He should be dead.
He would be, if his mother hadn't jumped in front of him.
Have you talked to him? Just briefly on the phone.
It's happening Mom.
It's happening to him.
He showed up in Chicago with this girl that he had just met and I knew he didn't have that much leave, but I- Mostly I just saw it.
I just felt it right away.
I should have called you.
I'm sorry.
But I didn't know what to do.
Then the MPs came and arrested him.
- Actually, I got him arrested.
- Abby, don't start.
This is not your fault.
No.
I needed to know.
I had to know, so I called here and I got his medical records and they had misdiagnosed a depression in May.
They thought it was stress, which is why he was transferred here.
We thought it was situational.
What? I made him see Dr.
McMangus.
You knew about his depression? McMangus is a mood-disorder specialist.
Even he thought it was PTSD.
PTSD? Mom, you' re bipolar.
Insomnia, loss of appetite, inability to concentrate.
It was all specific to the event and resolved without medication.
Do you even know anything about your disease? Yes, Abby.
I know a lot about it.
- Why didn't you just tell me? - I wanted to protect you.
Protect me? What about protecting him? Your brother didn't want you to know.
- Can't get a pressure.
- No femoral pulse.
Check a Doppler.
V- fib.
Crash cart.
Thoracotomy tray and prep the chest.
- It's blunt trauma.
- She had a pulse and was talking.
Ten blade.
Get FFP from the blood bank and page Cardiothoracic.
If they can get here.
- The husband wants to come in.
- No! Rib spreader.
- Metz and pickups.
- Nathan.
Sir, you've gotta come with me.
Sir? - No pericardial infusion.
- Oh, God.
- No cardiac lacerations.
- Satinsky.
Nathan, now.
- You've got to come outside with me.
- No.
- Starting compressions.
- I'm her husband.
She is bleeding into her chest.
They are trying to save her.
- The aorta is cross-clamped at 10: 27.
- Heart's empty.
- Empty? - Please, please.
Blood must be in the right chest.
Get me another tube.
- Set up a Thora-Seal.
- Dr.
Corday.
- Swab stick.
Suction on high.
- Boy's not oxygenating at 100 percent.
Carter thinks a rib punctured his heart.
- Squeeze in four units, then defibrillate.
-3-0 nylon and OpSite.
- What happened? - Rib lacerated his LAD.
He's got a huge V-Q mismatch, low PO-2 and diminished lung compliance.
Troponin is 32.
CK, 925 with 20 percent MB.
He's having a massive Ml.
- Cath lab first? - Probably heart muscle damage.
Okay.
Let's call Cards and set up for a Swan.
- Carter, Abby on 2.
- Get a number, see if I can call her back.
- Ectopy.
- You can't repair the coronary artery? - It would just be feeding a dead heart.
- Another run.
Ten beats.
Okay.
Okay, call a perfusionist.
We' re gonna put him on bypass.
- Bypass? - Just do it! Susan.
- Susan! - Neurosurg is on the way.
- All they can offer is ICP monitoring.
- No subdural? Diffuse cerebral edema with intraparenchymal bleeding.
Complete effacement of ventricles.
Knocked out the brainstem.
Get a stat EEG and mobilize transplant service.
- Transplant? - Toby? Is that Toby? I'm Dr.
Corday.
I need a word with you.
- Aren't you working on my wife? - I'm working on your family.
How bad is he hurt? He wasn't talking.
There's a massive swelling of his brain.
He's in a coma? No.
He's brain-dead, I'm afraid.
- Brain-dead? - I'm sorry.
- We still can't get a rhythm.
- Be right there.
-1500 cc's out the right side.
- Susan, can you help Luka? - Get him in the Suture Room.
- This is sudden.
But your other son, Matt, his heart is failing.
The artery that feeds it was severed by his rib.
His lungs are bruised and filled with blood.
His only chance is a heart and lung transplant within the next six hours.
Do you understand? School was canceled and the street was blocked and the boys wanted to make snowmen.
Sir, do you understand? I need your permission to take Toby's heart and lungs and give them to Matt.
- What? - This son is dead.
I might have a chance to save your other one.
- No, you just save them both.
- I can't.
- Elizabeth, you need to open a chest.
- Kids are resilient.
- He'll bounce back, right? - Elizabeth, I might need you.
- Not now.
- Drunken driver with distracting injuries.
No! Look, I know this is difficult, but I need your consent now.
You can't just wait a couple days? See if he wakes up? Elizabeth.
Sir, I'll be right back.
Nathan.
You need to calm him down, explain it to him, get consent.
He's not in the state of mind to understand.
So you make him understand.
We just have one shot at his other boy.
What, they' re worried about national security? It's protocol.
Military's big on it.
They already said they'd discharge him.
How long can it take to talk to a lawyer? I guess he needed to brief him on the hearing.
There's a PX.
You want something to eat? No, thanks.
You haven't eaten anything since last night.
I'm fine.
- Mrs.
Wyczenski? - She's fine too.
Look, Gallant, you came here to help me get on base, and I got on base.
Thank you.
Now you should go.
- I mean, I can stay.
- You have a test.
- But Dr.
Carter said if I did need- - I don't care.
Dr.
Carter's not here.
And besides, this is my family.
You should go.
- Well, there's only one car.
- Mom, do you have a rent-a-car? - Yes.
- You can take it.
- Come on, go.
Go.
- I'm gonna take him over in 45 minutes.
- Can I go in now? - He asked to see his mom.
- Let's go.
- Only his mom.
- Does he know I'm here? - Yes, ma'am.
And he doesn't wanna see me? Not right now, ma'am.
I'll talk to him, Abby.
He'll come around.
Right this way.
Spreader.
At least 2 more liters in the right chest.
- Suction.
- Vascular clamp.
- Looks like a hilar injury.
- Tore the pulmonary artery and vein.
- Got it.
- Resuming compressions.
- Is he getting consent? - He's trying.
- HemoCue, 6.
2.
- Comes in handy, I guess.
- What? - He's good at talking patients into stuff.
- Another eight of packed cells.
- She's in arrest too long.
- We only got hemostasis a minute ago.
- He's in V-tach! - Four units on the rapid infuser.
- Thirty-five kilos.
Charge to 50.
- Where's my perfusionist? - Still trying to get through the snow.
- .
35 mg of one to 10,000 of epi.
- Sinus.
- Okay, bolus lidocaine and- - V-tach.
Pulseless.
- Starting CPR.
- All right, 120 again.
I got it.
- He consented? - I showed him the EEG.
Everybody clear.
- All right, sinus.
He wants to convert.
- V-tach.
Heart's ischemic, lungs can't oxygenate.
Move to the OR.
We don't have a stable rhythm yet.
Lidocaine, IV push and charge.
- You got a signature? - He's signing now.
And clear.
- Sinus.
- Okay, then get his brother upstairs.
- Hold right there.
- We need that transplant team here now.
- Back to V-fib.
- Damn it.
All right, charge again to 120.
Procainamide, 300 mg IV over the next half-hour.
- Charge again.
- Wait.
- Back to sinus.
- Okay, that's it.
Let's go.
Lido infusion at 40 mics per kilo per minute.
- We shouldn't move him.
- We have a window.
He's in sinus now.
- For 10 seconds.
- We need to get him on bypass.
- He can't last that long.
- You wanna do a heart transplant? You have any other ideas? I'm here, kiddo.
It's not gonna hurt.
I'm here.
We'll set up.
Have the bypass catheters standing by.
- Subclavian? - No.
Femoral.
Ten French.
- Ectopy again.
We gotta hustle.
- What's wrong? - Hey, hold the elevator! - Sats down to 78.
- He needs to be suctioned.
- You gotta make this work.
- We'll do our best.
- No, promise me.
- Promise me this will work.
- We have to get upstairs.
Pressure's down to 80 systolic.
Let's open up the dopamine box.
It's okay, baby.
You' re gonna help your brother, okay? You' re gonna help your brother.
My wife.
If we bring him in to my wife, she's gotta say goodbye.
- Amp of bicarb in.
- I think I just broke his last rib.
Good pulse with compressions.
Where are we headed? - OR 2.
- V-fib! - Hold compressions.
Charge the paddles.
- Charging.
Clear.
- Battery's dead.
- Check the connection.
- Still energized.
- Okay, stop.
Clear! There's a crash cart in the OR.
- Let's go.
Grab the slider.
- One-fifty.
- Charged.
- Clear.
Sinus.
Three milligrams per kilo of heparin - then prep for THI cannula.
- One, two, three.
- Where's my transplant team? - What do you want me to do? - Keep him in V-fib.
- Heparin's in.
Waiting on gradient.
- Run a V-tach.
Half-bolus of lidocaine.
- Two hundred units per kilo.
- Sinus.
- Then one per mil of prime.
- Shirley? - Right here.
Meet the donor at the elevator.
Get him prepped next door.
- Repeat BP.
-100/60.
Ten blade.
Starting bypass at 11:46.
- Hey.
- Just got him hooked up now? LAD is shredded.
Irreversible ischemic damage to left ventricle.
And I thought I had a snow day.
Get the harvest team going.
Keep pH at 7.
4.
PCO2 between 30 and 35.
Yeah.
Yeah.
He doesn't blame you.
He just can't hide from you.
You saw him manic, and he hasn't accepted it yet.
He's taking the meds.
Not by choice.
That could take some time.
He's emotionally exhausted.
And he's ashamed.
Try not to be confrontational.
I've got this down.
Thanks.
Hi.
Were you expecting a straitjacket? No.
You look nice.
Fashion's key at a court martial.
It's not really a court martial, right? It's a Rule 70- I know what it is, Abby.
You wanted out anyway, right? Yeah.
It's all a ploy.
You know I love you, right? You know that.
I was worried about you because I love you.
- And you think I'm crazy? - No, not crazy.
Oh, right.
Sick.
Mentally unstable.
Suddenly plagued by a psychiatric illness.
Truth is I was having a pretty good time.
I want you to come back to Chicago with me.
That sounds like a lot of fun.
Maybe you could call the MPs again.
Eric, you've seen this.
You know if you don't stay medicated, it can get bad.
I mean, bad.
- You could end up wasting- - Abby, she's right here.
I know she is.
It's not a secret.
She knows it.
She'll tell you.
She will tell you.
Mom, tell him.
Tell him, Mom! Mom, tell him.
I'll be in the waiting room.
- What the hell, Abby? - Yeah, what the hell? You called her? You didn't-? It took me three days to find you.
- I talked my way in here.
- I didn't ask you to.
But you called her? The most unreliable, undependable person in our lives? - And you' re dependable.
- Yeah.
To you, I am.
Yes.
Then I'm sorry.
I have to apologize to poor Abby.
Poor, poor Abby.
My career is over, but she doesn't get to be the savior again.
You need help.
Mom screwed up the first time you went to her.
One, I don't need help.
And two, I didn't go to her.
She thought she saw something.
She dragged me to her doctor.
I went to make her happy, and her doctor proved her wrong.
She wasn't wrong.
Then why am I not allowed to call her? Better get going, sergeant.
Hey, make sure you check my knee too.
It's killing me.
I hit it on the steering column.
- Did you hear me? - Yes.
Then get me something for the pain, brother.
All the alcohol wasn't enough, brother? - I only had one beer.
- This the driver? Right-side tenderness.
The ultrasound looks clear.
Hey, what's your problem, man? You got Tourette's or something? - Did you do it? - Ask me in six hours.
The transplant team's working.
- Did you talk to the father? - Large seat-belt contusion.
- Safety first.
- They let you be a doctor like this? Only on the patients they don't care about.
Hey, did you just dis me, man? I think he just dissed me.
Do you know what you did? - Do you have any idea? - Yeah.
I banged up my knee.
You killed a whole family! A mother, her two kids! - No.
I hit a snowman.
- They were making a snowman, you jerk! Perhaps you should help out with another patient.
You have to give him time, Abby.
Oh, now you speak? Now you have an opinion? He can't feel we' re ganging up on him.
- Just don't push him.
- I didn't push him.
You were already talking about going back to Chicago.
They are discharging him, Mother.
Where do you suggest we put him up, in a psychiatric hospital in Omaha? I'm not so sure he should be hospitalized.
Well, that's not really your decision.
Is it yours? You know, he only looks normal because he's on Depakote.
- And if you had seen him- - I know the pathology, sweetie.
And, yes, the easy thing would probably be to try to commit him.
Easy? But he's got to accept the disease, accommodate it.
And until he does, he needs to be supervised or he will go off his meds.
You always did.
Well, he probably will at one time or another.
But, Abby, trust me on this.
It's like AA.
It's got to be his decision.
He's got to want it.
And it's way too early for that.
Mom I have been living with this disease my entire life.
Please don't lecture me on it.
I know you've been living with this your entire life - but you've never been inside it.
- What is that? What is that? " Inside it"? Like you two have some sort of special bond now? - Because you' re both inside of it? - Abby, stop it.
This is about Eric.
You can't go back to the way you two were.
There's no quick fix.
Your brother will be struggling with this for the rest of his life.
Abby.
- Has she been vomiting? - Twice this morning.
She started to run a fever so I brought her in.
Is anybody else sick at home? Her little brother had an earache a couple days ago, but he seems fine.
- Let's take a look.
- God knows where they've been.
Well, you can't take my blood alcohol.
I don't give you permission.
We don't need your permission.
- So you hungry at all, Kiley? - No.
- Any diarrhea, Mom? - No.
- I'm sorry.
- What happened? It was an accident.
I scared her more than anything else.
- Are you all right? - Did you hit the TM? He just jammed that thing in her ear.
- I don't think I really hurt her.
- Well, why is she crying? - Here.
- Where you going? - I'm going home.
- Come back here and finish the workup.
No, thank you.
We were able to get Matt stabilized on bypass.
The transplant team's at work.
Is there anybody you'd like me to call? When will you know? It's a delicate procedure, especially on children.
There's a waiting room on the third floor.
I can't seem to walk out of this room.
What time is it? It's almost 5.
I'd be getting home about now.
Silvia would probably pick up a pizza or some Chinese because she got busy with the boys after school and didn't have time to cook.
Toby would have a picture that he drew that he'd want me to look at.
And Matt would want me to test him on his math.
You made the right decision.
The only one you could.
We woke up this morning everything was white.
They were so happy.
We all got to stay home.
It may not seem like it but I know what you' re feeling.
- I understand what you' re feeling.
- I'm sorry, doctor, but you You don't know what I'm feeling.
You don't have any idea.
I don't even know.
My husband his name was Mark.
He died- My God, I was about to say last year.
It was only six months ago.
I tried to pretend once Mark was gone, that I could pull myself up, continue like normal.
But it doesn't work like that.
You see, you can't run away from it.
It's like this big, relentless wave that you have to ride.
But in riding it, somehow you hold on to what you've lost.
And you find a way to go on without shutting off.
It's not easy, but you do it.
I know someday soon when you look into your child's eyes all you will see are the beautiful things that live on in him.
He needs to be okay.
I need him to be okay.
He will be.
He will be.
Based on his testimony, they don't have enough information to conclude - that he was mentally incompetent.
- Why is he here? - He's demanding due process.
- He needs to stay medicated.
I'll contact the convening authority to get him released from pre-trial confinement.
The door doesn't open from the inside.
Pick up the phone when you' re finished.
- You requested a court martial? - No.
- That's what the lawyer says- - I was gone less than 30 days.
The worst they'll do is discharge me, maybe a couple weeks' confinement.
You don't have a couple of weeks.
I haven't hurt anyone.
I haven't broken any laws.
I haven't acted irresponsibly.
- I just needed a change.
- You went AWOL.
That's between me and them.
They want me to say I'm crazy.
I won't say it.
- Nobody's saying you' re crazy.
- You are.
- No, I'm not.
- Come on, Abby.
You were there.
You even tried to hide it from me.
Mom was crazy.
She was out-of-her-mind crazy.
And I'm not like that! I'm not her.
You can say it all you want.
I'm not her.
Hey.
Shirley, she said she saw you out here on her break almost an hour ago.
You okay? No symptoms.
It's perfect timing, huh? You need something? I owe it to you to give you this in person.
Your evaluation.
- You' re not going to open it? - Open it for what? There's no middle ground with you, is there? - Blind optimism or self-pity.
- It's just the truth.
It's gonna cripple me.
Just when I learn how to deal with another symptom, it progresses.
- What were you expecting? - Time.
I expected time.
Enough time to figure out a Time's gonna kick my ass.
So, what, that's it? You' re just gonna give in? - Isn't that what you wanted? - No.
No.
I wanted you to recognize your limitations.
I thought you were trying to prove something.
But you probably saved that little boy's life today.
You connected with his father when he was completely lost.
You guided him to make the right decision.
Any idiot can suture a wound, put in a chest tube.
But you have a gift, Mr.
Nathan.
The gift of a physician.
Now it's up to you to decide if you want to share that gift.
And then find a way.
By the way, I keep my promises.
I failed you.
All they have is Diet Shasta.
- They still make this? - I hope so.
They might ask you to testify, you know.
Yeah.
Mom, I need you to be with me on this.
He can't stay in military jail.
I'm with you.
I'm sorry.
I'm just scared for him and I'm angry.
I'm angry at you for having to do this again.
- And you didn't do anything.
- No.
- You're angry at me for giving it to him.
- No, no.
I didn't- I know you feel like a mother to him.
Why shouldn't you? You practically raised him.
You have a right.
But I'm his mother and I gave it to him.
I gave it to my son.
All I can do now is try to be his mother.
- I'm sorry.
I gave his lawyer this number.
- I'm gonna try to find us a hotel room.
This may take a few days.
- Hello? - Hey, you turned on your cell phone.
- Hi.
- Well, did you find him? Yeah, I found him.
They might court-martial him, but I found him.
Did you tell them that he's sick? They already knew.
It's a long story.
- You still snowed in? - Oh, the city's a mess.
How are you holding up? - Do we have any spare monitors? - For what? - Fiber-optic otoscope.
- Oh, try Trauma Hall.
Good news.
Your appendix appears normal.
- No swelling or inflammation.
- Can she get something to eat? - She's getting her appetite back.
- A good sign.
- What do you feel like eating, Kiley? - Pizza.
Pizza.
That sounds good.
But you should have some soup until your tummy's settled.
All right.
CT's negative.
She can go home.
Drink some clear liquids, and come back tomorrow.
Excuse me, Dr.
Weaver.
- I never finished checking Kiley's ear.
- You don't have to.
We' re fine.
It's okay.
I'm not gonna hurt her.
- Can you help me? - Tell him we' re fine.
Don't worry.
She's safe.
I think I saw something, so I want you to hold the scope and put it in your ear very gently.
You even get to watch it on TV.
- Me? - Yeah.
You get to be the doctor.
- Is that my ear? - Actually, it's your eardrum.
- Gross.
- Use cotton swabs? - Yeah, every night.
- See, that's the problem.
The cotton swab rubs the protective wax.
It can cause an ear infection.
- And what can you do about that? - Well, I could give her some drops.
It's better if she never sticks anything in her ear smaller than her elbow.
- My elbow? I can't fit my elbow.
- You can't? - Mr.
Nathan, are you almost finished? - Yeah, almost.
- You' re needed upstairs.
- What is it? Field is dry.
Anastomosis site's intact.
You' re either gonna make me famous or get me arrested for cases like this.
Dr.
Nathan, Dr.
Carmichael.
I toil for eight hours, and you get the honors.
- Excuse me? - Over here.
Cardioplegia solution is withdrawn.
Okay.
Shut it down.
This is where you jump from the plane and hope you packed the chute correctly.
- Better grab those paddles.
- What? Paddles.
We' re gonna need them.
V- fib.
That's your cue.
Clear.
Heart rate, 70.
And that, my friends, makes it all worthwhile.
Start the epi.
Take down the catheters.
I guess his brother will always be with him.
R.
- What's the appeal process? - A promise.
You must give me your word that you will never treat patients.
- No.
- Then you will fail, Mr.
Nathan.
- You called the MPs? - No.
- Why did you do this? - Youre under arrest for unauthorized - absence from the U.
S.
Air Force.
- Wait; hold on a second, guys.
Lock me up and throw away the key.
Eric's been a bad boy! Thanks a lot, Abby! Thank you! It's Sergeant Eric Wyczenski.
Whiskey, Yankee, Charlie, Zulu, Echo, November, Sierra, Kilo, India.
- Wyczenski.
- Could you tell me his squadron number? Hold on.
Do you know his squadron number? I don't know.
I'm not sure.
You don't have a central directory? Johnny's up.
He pulled out his Hep-Lock.
Get Conni.
I'm off.
No, no.
I'm calling on behalf of a family member.
Okay.
Then can you transfer me to the confinement facility? - Stop staring! - They don't talk to family members.
- I'm not gonna lie.
- I just wanna know where he is! - Stop staring! - She offered her cat a teaspoon of acid.
- Get away, freak-o.
- Sine equals cosine- Hello? Lieutenant Michael Gallant, U.
S.
Army Reserve.
- What are you doing? - Are you deaf? I said, get away! - Stop it.
- He won't stop staring.
- He's not hurting anybody.
- He smells like piss, man.
- This way.
This way.
- Keep the mental cases locked up.
- It's irrational, but it has a fraction- - He's not at Great Lakes.
- I kept trying to call you.
- Couldn't get a phone signal on the base.
- Sit down.
- It's a rule.
It's a constant.
But they did keep Eric there on Thursday night.
- They told you that? - They held Eric there three nights ago - then transferred the next morning.
- Transferred him where? Nebraska, his base.
Might as well be Manila.
There's, like, 100 offices on that base.
Is that Army or Air Force? I was desperate.
I thought he could use military lingo or something.
Great, thanks.
Okay.
So they gave me the number to the 55th Wing Judge Advocate's Office.
I left five voice mails there.
They' re closed all weekend.
Did you get the name of his attorney? - I can call back.
- That's okay.
Thanks.
I'm just gonna go there.
I'm just gonna go there.
Okay.
Why don't I call the travel agent, see if we can book a flight out for tomorrow.
- I wanna go tonight.
- Confirm he's there.
I've been trying to confirm where he is for three and a half days.
- Is there a flight out tonight? - Yep.
United, 9:30 to Omaha.
My shift just started five minutes ago.
I can't dump it now.
- You don't have to come.
- You can't go by yourself.
- I usually do this by myself.
- Let me find Chen to cover for me.
She left five minutes ago.
Do you even know how to get onto a military base? - There must be a visitor's center.
- You have to have a sponsor.
- I'll figure it out.
- At least take Gallant with you.
- That's what I need, a med student.
- To us, he's a med student.
- To them, he's an officer.
- He has things to do.
He's been on a base before.
He speaks the lingo.
Can you call me a cab, please? Maybe some T-shirts.
They' re in the third drawer on the right from the bottom.
Just pick out anything that doesn't look like I slept in it.
What about toiletries? Toothbrush, toothpaste? I'll just buy that stuff when I get out there.
And socks and underwear in the second drawer.
Pull them from the top.
- Why? - Because those are my respectable- Oh, right, and - Were they open? - Yeah.
Just made it.
- What? - Dry cleaner.
- My uniform.
- Thought it might help.
- You don't have to do this, Gallant.
- Never been to Omaha.
What's that? Internal medicine exam next week.
Oh, that's great.
You coerced a med student into failing his rotation.
I'm on a 10:00 flight.
I get in at 11:30.
- Call me if you need anything.
- When are you gonna sleep? Just get in the cab.
Thank you.
I'll see you in Nebraska.
Okay, Frank, what do we got? Let's see.
Four-F with abdominal pain in Exam 3.
five hundred and 10, equals 284.
Jacob gave Esau 220 goats and 220 sheep.
Come on, Johnny.
Let's see if we can't get you something to eat.
Come on, foot.
Come on.
Come on.
You say delayed, but you mean canceled.
- No, sir - Well, how long does that usually take? - Go ahead.
- Can you give me any estimate? - Go ahead.
I got it.
- I could be here a while.
Go ahead.
Well, have they even started to plow the runways yet? No task on the agenda has priority over the number 200.
Sum of the main diagonal should be equal to the sum of each row.
Now, that's tricky, but it's part of the magic.
Must be equal.
Must be all.
Sum of the major diagonal should be equal to each row and each column.
Now, that's more tricky, but it can be done if you know the secret.
Sum of three numbers geometrically equidistant from the center - You okay? - Yeah.
It's just worse when I wake up.
At least you got some sleep.
- Hey, did it stop snowing? - Yeah.
But don't expect to go anywhere.
- I got another 12 hours anyway.
- At least they'll be quiet.
- Hello? - John.
Hey.
Hang on.
- Hey, where are you? - Looking for Eric's commanding officer.
- You got on the base.
- Yeah.
You were right.
Gallant's a fast talker.
I'm looking at one of those stealth plane things right now.
- You see the news? - What? - I said, did you see the news last night? - No.
What happened? Three feet of snow dumped in seven hours.
Carter, I can't hear you.
Three feet of snow dumped in seven hours last night.
The airport's closed.
I'm at work.
I can't get my car out of the parking garage.
El's shut down.
The El.
Forget it.
Is he there? Eric.
Is he there? I don't know.
Nobody seems to know anything, actually.
I thought the military was supposed to excel in communications.
They had trouble giving direction on where to park much less You all right? - Yeah, I'm fine.
- Carter? No, no.
Not you.
- What? - Off the phone! You' re a civilian in a restricted area.
Get off the phone.
- I'll call back.
- Tell her to get off the phone.
Talk to you later.
Your office issued a visitor's pass and suggested we look for you in Hangar 12.
That, lieutenant, is Hangar 13.
- "Oh," what? - Oh, sir.
- Sir.
- You're Wyczenski's sister? - Yes.
- Funny guy.
Popular too.
Unfortunately, he didn't feel much responsibility to the Air Force.
Is he here? Because nobody's telling us anything.
Ma'am, I just came off of a 72-hour live-fire exercise short one air-traffic controller.
- If Sgt.
Wyczenski was apprehended- - Aren't you his commanding officer? If he was picked up in Chicago, he would be brought here.
Go to your hotel.
Leave your number with my office.
He's suffering from a psychiatric disorder.
I'm well aware of the " near-miss" depression.
Bipolar disease.
Manic depression.
He needs to see a psychiatrist.
He needs to be evaluated and medicated now.
So wherever he is, wherever you seem to have lost him, he needs help.
- snow day for all city offices and school - Did you hear that? - Closed.
City offices.
Read the sign.
We' re county.
They haven't plowed the bay.
They' re having trouble getting on the road.
Chuny, Lydia wants to know, since you' re stuck here, if you'll take her shift.
Tell her to break out the shovel.
Hey, repeat troponin's negative on 5.
Send him home with a sled and some Huskies.
- It is so quiet.
- I know.
Kind of freaky, huh? - So you trying to rent a snowmobile? - Considering it.
- Do they deliver? - I can't get them to answer the phone.
Rack is empty, Triage is clear and labs are pending on my only two patients.
- Good.
- So, what do I do now? I don't know.
Go play in the snow.
Hey, Ella! Please tell me daycare's open.
There's a kindergarten teacher in Exam 4.
My nanny couldn't get out of her front door.
- That's what windows are for.
- I'm soaked to my knees.
- All we did was walk from the El.
- The El's open? - I wouldn't do that if I were you.
- We're outside.
- On an Air Force base.
- Do you need clearance to smoke too? You can't talk on a cell phone.
You can't smoke.
You see that truck? - Yeah.
- That's jet fuel.
- Amy Lockhart? - Abby.
Lieutenant Ottenson, your brother's detailed counsel.
- Has he been charged with something? - No.
Not officially.
- Acting combative or argumentative? - I don't know.
- Delusional? - I haven't seen him.
I just got the jacket.
Can I go in there? I really need to talk to him.
- He's not here.
The judge advocate- - Wait a minute! Wait! His CO said that they took him to confinement Friday afternoon.
And transferred to base hospital Saturday morning.
Oh, my God! I'm so sorry.
I'm sorry.
- I thought you were Malik.
- Do I look like Malik? Sorry, man.
You ain't that good-looking.
- What are you doing? - You told me to play in the snow.
You can't let him outflank you like that.
Yeah, right.
- Commuting on skis.
- What? - You' re skiing to work.
- Yeah.
I don't live far.
- Nice coat.
- Goodwill box.
- Hey, did you find him? - Who? Abby's brother.
I'm gonna catch a train to Midway and wait for it to open up.
- Where are you going? - Nebraska.
She's already there.
She left last night.
- You didn't go with her? - I had a shift.
- I sent Gallant with her.
- Gallant? - Yeah.
Why? - Carter, we've got multiples coming in.
- Luka's here.
- Three criticals.
One adult, two kids.
Some drunk plowed through a family making a snowman in their front yard.
- Where's Weaver? - She can't get her car out.
The El's running.
It's hard walking through the snow with a cane.
She's disabled, remember? I thought we were closed to ambulance traffic.
How's anybody gonna get in? We'll do a hot unload.
Stay with me.
Approach the helicopter from the front.
It'll be windy as hell up there.
If anything blows away, don't chase it.
- It's far too easy to become disoriented.
- Right.
- You need some help? - I've got it.
Your stethoscope will be useless.
So will your ears, for that matter.
Rely on your other senses.
Look for chest excursion, feel the pulses, study the monitor.
Pulse ox, ECG, dynamap.
They'll tell you all you need to know about the status.
Don't even try to take a history until- You have a tremor on the left.
That's the Sinemet.
It works faster when I chew it.
I've only noticed it on the right.
Have you had symptoms on the left before? - Stress, you know.
Sleep deprivation.
- Or a progression of your disease.
My rotation's almost over.
Why do you do this to yourself? Working these insane hours when you- Please don't treat me like I'm dying, okay? Can we just go get this patient? Keep your head down.
Stick with me and stay clear of the tail rotor.
- They gave him a drug called "Depacot.
" - Depakote.
- And Zy- - Zyprexa.
Apparently, he's coherent.
He's scheduled to go up against a Rule 706 sanity board at 1200.
- "Up against"? - It's just a formality.
- If he was psychotic- - " Manic, " actually, is the term.
Manic.
Then they won't court martial.
They'd process him on medical discharge.
How long will they hold him? If he's mentally stable, they'll release him.
No one calls me to get a family history or gives me time to set up treatment for him? You'll just boot him out? If he'd asked for family, someone would have contacted you.
- He's not thinking clearly.
- Abby.
Hi.
Hi.
The doctor's in with him now.
- Name? - Mother's screaming for Toby and Matt.
- I don't know which is who.
- Toby.
The other one's Matt.
Cushing's response.
Vital signs negative.
No hemotympanum.
Pupils blown.
Seven mm bilaterally non-reactive.
No corneal or gag reflex.
His brain is mush.
- Tell me the drunk driver died on impact.
- It was one of those monster trucks.
- He hit the whole family? - Dad was getting a carrot for the nose.
- CT's ready.
- Scan the belly along with the head.
- I need to get to the other one.
- Epidural hematoma? - If we' re lucky.
- Set me up for a central line.
- Pulse ox is only 85.
- Is that the mother? - C-spine is clear.
- Jumped in front.
Truck hit straight on.
- Does your belly hurt, ma'am? - Chest.
Flail segment.
Thirty-two French.
Please.
My boys.
Please, save my boys.
Full trauma panel.
Type and cross for 4, portable chest and pelvis.
Another unit on the second line.
Let's set up for a femoral.
- We have blood? - We'd better.
He's got contusions and crepitus over the left chest.
- They left my mom.
- No, they didn't.
- They left her in the snow.
- Follow this light with your eyes.
- She's here.
We' re helping her.
- Where's Toby? He's here too.
Decreased on both sides.
Bilateral thoracostomy.
- Ten blade.
- Times two.
Pressure's holding, but he's tachy.
All his ribs are shattered.
He should be dead.
He would be, if his mother hadn't jumped in front of him.
Have you talked to him? Just briefly on the phone.
It's happening Mom.
It's happening to him.
He showed up in Chicago with this girl that he had just met and I knew he didn't have that much leave, but I- Mostly I just saw it.
I just felt it right away.
I should have called you.
I'm sorry.
But I didn't know what to do.
Then the MPs came and arrested him.
- Actually, I got him arrested.
- Abby, don't start.
This is not your fault.
No.
I needed to know.
I had to know, so I called here and I got his medical records and they had misdiagnosed a depression in May.
They thought it was stress, which is why he was transferred here.
We thought it was situational.
What? I made him see Dr.
McMangus.
You knew about his depression? McMangus is a mood-disorder specialist.
Even he thought it was PTSD.
PTSD? Mom, you' re bipolar.
Insomnia, loss of appetite, inability to concentrate.
It was all specific to the event and resolved without medication.
Do you even know anything about your disease? Yes, Abby.
I know a lot about it.
- Why didn't you just tell me? - I wanted to protect you.
Protect me? What about protecting him? Your brother didn't want you to know.
- Can't get a pressure.
- No femoral pulse.
Check a Doppler.
V- fib.
Crash cart.
Thoracotomy tray and prep the chest.
- It's blunt trauma.
- She had a pulse and was talking.
Ten blade.
Get FFP from the blood bank and page Cardiothoracic.
If they can get here.
- The husband wants to come in.
- No! Rib spreader.
- Metz and pickups.
- Nathan.
Sir, you've gotta come with me.
Sir? - No pericardial infusion.
- Oh, God.
- No cardiac lacerations.
- Satinsky.
Nathan, now.
- You've got to come outside with me.
- No.
- Starting compressions.
- I'm her husband.
She is bleeding into her chest.
They are trying to save her.
- The aorta is cross-clamped at 10: 27.
- Heart's empty.
- Empty? - Please, please.
Blood must be in the right chest.
Get me another tube.
- Set up a Thora-Seal.
- Dr.
Corday.
- Swab stick.
Suction on high.
- Boy's not oxygenating at 100 percent.
Carter thinks a rib punctured his heart.
- Squeeze in four units, then defibrillate.
-3-0 nylon and OpSite.
- What happened? - Rib lacerated his LAD.
He's got a huge V-Q mismatch, low PO-2 and diminished lung compliance.
Troponin is 32.
CK, 925 with 20 percent MB.
He's having a massive Ml.
- Cath lab first? - Probably heart muscle damage.
Okay.
Let's call Cards and set up for a Swan.
- Carter, Abby on 2.
- Get a number, see if I can call her back.
- Ectopy.
- You can't repair the coronary artery? - It would just be feeding a dead heart.
- Another run.
Ten beats.
Okay.
Okay, call a perfusionist.
We' re gonna put him on bypass.
- Bypass? - Just do it! Susan.
- Susan! - Neurosurg is on the way.
- All they can offer is ICP monitoring.
- No subdural? Diffuse cerebral edema with intraparenchymal bleeding.
Complete effacement of ventricles.
Knocked out the brainstem.
Get a stat EEG and mobilize transplant service.
- Transplant? - Toby? Is that Toby? I'm Dr.
Corday.
I need a word with you.
- Aren't you working on my wife? - I'm working on your family.
How bad is he hurt? He wasn't talking.
There's a massive swelling of his brain.
He's in a coma? No.
He's brain-dead, I'm afraid.
- Brain-dead? - I'm sorry.
- We still can't get a rhythm.
- Be right there.
-1500 cc's out the right side.
- Susan, can you help Luka? - Get him in the Suture Room.
- This is sudden.
But your other son, Matt, his heart is failing.
The artery that feeds it was severed by his rib.
His lungs are bruised and filled with blood.
His only chance is a heart and lung transplant within the next six hours.
Do you understand? School was canceled and the street was blocked and the boys wanted to make snowmen.
Sir, do you understand? I need your permission to take Toby's heart and lungs and give them to Matt.
- What? - This son is dead.
I might have a chance to save your other one.
- No, you just save them both.
- I can't.
- Elizabeth, you need to open a chest.
- Kids are resilient.
- He'll bounce back, right? - Elizabeth, I might need you.
- Not now.
- Drunken driver with distracting injuries.
No! Look, I know this is difficult, but I need your consent now.
You can't just wait a couple days? See if he wakes up? Elizabeth.
Sir, I'll be right back.
Nathan.
You need to calm him down, explain it to him, get consent.
He's not in the state of mind to understand.
So you make him understand.
We just have one shot at his other boy.
What, they' re worried about national security? It's protocol.
Military's big on it.
They already said they'd discharge him.
How long can it take to talk to a lawyer? I guess he needed to brief him on the hearing.
There's a PX.
You want something to eat? No, thanks.
You haven't eaten anything since last night.
I'm fine.
- Mrs.
Wyczenski? - She's fine too.
Look, Gallant, you came here to help me get on base, and I got on base.
Thank you.
Now you should go.
- I mean, I can stay.
- You have a test.
- But Dr.
Carter said if I did need- - I don't care.
Dr.
Carter's not here.
And besides, this is my family.
You should go.
- Well, there's only one car.
- Mom, do you have a rent-a-car? - Yes.
- You can take it.
- Come on, go.
Go.
- I'm gonna take him over in 45 minutes.
- Can I go in now? - He asked to see his mom.
- Let's go.
- Only his mom.
- Does he know I'm here? - Yes, ma'am.
And he doesn't wanna see me? Not right now, ma'am.
I'll talk to him, Abby.
He'll come around.
Right this way.
Spreader.
At least 2 more liters in the right chest.
- Suction.
- Vascular clamp.
- Looks like a hilar injury.
- Tore the pulmonary artery and vein.
- Got it.
- Resuming compressions.
- Is he getting consent? - He's trying.
- HemoCue, 6.
2.
- Comes in handy, I guess.
- What? - He's good at talking patients into stuff.
- Another eight of packed cells.
- She's in arrest too long.
- We only got hemostasis a minute ago.
- He's in V-tach! - Four units on the rapid infuser.
- Thirty-five kilos.
Charge to 50.
- Where's my perfusionist? - Still trying to get through the snow.
- .
35 mg of one to 10,000 of epi.
- Sinus.
- Okay, bolus lidocaine and- - V-tach.
Pulseless.
- Starting CPR.
- All right, 120 again.
I got it.
- He consented? - I showed him the EEG.
Everybody clear.
- All right, sinus.
He wants to convert.
- V-tach.
Heart's ischemic, lungs can't oxygenate.
Move to the OR.
We don't have a stable rhythm yet.
Lidocaine, IV push and charge.
- You got a signature? - He's signing now.
And clear.
- Sinus.
- Okay, then get his brother upstairs.
- Hold right there.
- We need that transplant team here now.
- Back to V-fib.
- Damn it.
All right, charge again to 120.
Procainamide, 300 mg IV over the next half-hour.
- Charge again.
- Wait.
- Back to sinus.
- Okay, that's it.
Let's go.
Lido infusion at 40 mics per kilo per minute.
- We shouldn't move him.
- We have a window.
He's in sinus now.
- For 10 seconds.
- We need to get him on bypass.
- He can't last that long.
- You wanna do a heart transplant? You have any other ideas? I'm here, kiddo.
It's not gonna hurt.
I'm here.
We'll set up.
Have the bypass catheters standing by.
- Subclavian? - No.
Femoral.
Ten French.
- Ectopy again.
We gotta hustle.
- What's wrong? - Hey, hold the elevator! - Sats down to 78.
- He needs to be suctioned.
- You gotta make this work.
- We'll do our best.
- No, promise me.
- Promise me this will work.
- We have to get upstairs.
Pressure's down to 80 systolic.
Let's open up the dopamine box.
It's okay, baby.
You' re gonna help your brother, okay? You' re gonna help your brother.
My wife.
If we bring him in to my wife, she's gotta say goodbye.
- Amp of bicarb in.
- I think I just broke his last rib.
Good pulse with compressions.
Where are we headed? - OR 2.
- V-fib! - Hold compressions.
Charge the paddles.
- Charging.
Clear.
- Battery's dead.
- Check the connection.
- Still energized.
- Okay, stop.
Clear! There's a crash cart in the OR.
- Let's go.
Grab the slider.
- One-fifty.
- Charged.
- Clear.
Sinus.
Three milligrams per kilo of heparin - then prep for THI cannula.
- One, two, three.
- Where's my transplant team? - What do you want me to do? - Keep him in V-fib.
- Heparin's in.
Waiting on gradient.
- Run a V-tach.
Half-bolus of lidocaine.
- Two hundred units per kilo.
- Sinus.
- Then one per mil of prime.
- Shirley? - Right here.
Meet the donor at the elevator.
Get him prepped next door.
- Repeat BP.
-100/60.
Ten blade.
Starting bypass at 11:46.
- Hey.
- Just got him hooked up now? LAD is shredded.
Irreversible ischemic damage to left ventricle.
And I thought I had a snow day.
Get the harvest team going.
Keep pH at 7.
4.
PCO2 between 30 and 35.
Yeah.
Yeah.
He doesn't blame you.
He just can't hide from you.
You saw him manic, and he hasn't accepted it yet.
He's taking the meds.
Not by choice.
That could take some time.
He's emotionally exhausted.
And he's ashamed.
Try not to be confrontational.
I've got this down.
Thanks.
Hi.
Were you expecting a straitjacket? No.
You look nice.
Fashion's key at a court martial.
It's not really a court martial, right? It's a Rule 70- I know what it is, Abby.
You wanted out anyway, right? Yeah.
It's all a ploy.
You know I love you, right? You know that.
I was worried about you because I love you.
- And you think I'm crazy? - No, not crazy.
Oh, right.
Sick.
Mentally unstable.
Suddenly plagued by a psychiatric illness.
Truth is I was having a pretty good time.
I want you to come back to Chicago with me.
That sounds like a lot of fun.
Maybe you could call the MPs again.
Eric, you've seen this.
You know if you don't stay medicated, it can get bad.
I mean, bad.
- You could end up wasting- - Abby, she's right here.
I know she is.
It's not a secret.
She knows it.
She'll tell you.
She will tell you.
Mom, tell him.
Tell him, Mom! Mom, tell him.
I'll be in the waiting room.
- What the hell, Abby? - Yeah, what the hell? You called her? You didn't-? It took me three days to find you.
- I talked my way in here.
- I didn't ask you to.
But you called her? The most unreliable, undependable person in our lives? - And you' re dependable.
- Yeah.
To you, I am.
Yes.
Then I'm sorry.
I have to apologize to poor Abby.
Poor, poor Abby.
My career is over, but she doesn't get to be the savior again.
You need help.
Mom screwed up the first time you went to her.
One, I don't need help.
And two, I didn't go to her.
She thought she saw something.
She dragged me to her doctor.
I went to make her happy, and her doctor proved her wrong.
She wasn't wrong.
Then why am I not allowed to call her? Better get going, sergeant.
Hey, make sure you check my knee too.
It's killing me.
I hit it on the steering column.
- Did you hear me? - Yes.
Then get me something for the pain, brother.
All the alcohol wasn't enough, brother? - I only had one beer.
- This the driver? Right-side tenderness.
The ultrasound looks clear.
Hey, what's your problem, man? You got Tourette's or something? - Did you do it? - Ask me in six hours.
The transplant team's working.
- Did you talk to the father? - Large seat-belt contusion.
- Safety first.
- They let you be a doctor like this? Only on the patients they don't care about.
Hey, did you just dis me, man? I think he just dissed me.
Do you know what you did? - Do you have any idea? - Yeah.
I banged up my knee.
You killed a whole family! A mother, her two kids! - No.
I hit a snowman.
- They were making a snowman, you jerk! Perhaps you should help out with another patient.
You have to give him time, Abby.
Oh, now you speak? Now you have an opinion? He can't feel we' re ganging up on him.
- Just don't push him.
- I didn't push him.
You were already talking about going back to Chicago.
They are discharging him, Mother.
Where do you suggest we put him up, in a psychiatric hospital in Omaha? I'm not so sure he should be hospitalized.
Well, that's not really your decision.
Is it yours? You know, he only looks normal because he's on Depakote.
- And if you had seen him- - I know the pathology, sweetie.
And, yes, the easy thing would probably be to try to commit him.
Easy? But he's got to accept the disease, accommodate it.
And until he does, he needs to be supervised or he will go off his meds.
You always did.
Well, he probably will at one time or another.
But, Abby, trust me on this.
It's like AA.
It's got to be his decision.
He's got to want it.
And it's way too early for that.
Mom I have been living with this disease my entire life.
Please don't lecture me on it.
I know you've been living with this your entire life - but you've never been inside it.
- What is that? What is that? " Inside it"? Like you two have some sort of special bond now? - Because you' re both inside of it? - Abby, stop it.
This is about Eric.
You can't go back to the way you two were.
There's no quick fix.
Your brother will be struggling with this for the rest of his life.
Abby.
- Has she been vomiting? - Twice this morning.
She started to run a fever so I brought her in.
Is anybody else sick at home? Her little brother had an earache a couple days ago, but he seems fine.
- Let's take a look.
- God knows where they've been.
Well, you can't take my blood alcohol.
I don't give you permission.
We don't need your permission.
- So you hungry at all, Kiley? - No.
- Any diarrhea, Mom? - No.
- I'm sorry.
- What happened? It was an accident.
I scared her more than anything else.
- Are you all right? - Did you hit the TM? He just jammed that thing in her ear.
- I don't think I really hurt her.
- Well, why is she crying? - Here.
- Where you going? - I'm going home.
- Come back here and finish the workup.
No, thank you.
We were able to get Matt stabilized on bypass.
The transplant team's at work.
Is there anybody you'd like me to call? When will you know? It's a delicate procedure, especially on children.
There's a waiting room on the third floor.
I can't seem to walk out of this room.
What time is it? It's almost 5.
I'd be getting home about now.
Silvia would probably pick up a pizza or some Chinese because she got busy with the boys after school and didn't have time to cook.
Toby would have a picture that he drew that he'd want me to look at.
And Matt would want me to test him on his math.
You made the right decision.
The only one you could.
We woke up this morning everything was white.
They were so happy.
We all got to stay home.
It may not seem like it but I know what you' re feeling.
- I understand what you' re feeling.
- I'm sorry, doctor, but you You don't know what I'm feeling.
You don't have any idea.
I don't even know.
My husband his name was Mark.
He died- My God, I was about to say last year.
It was only six months ago.
I tried to pretend once Mark was gone, that I could pull myself up, continue like normal.
But it doesn't work like that.
You see, you can't run away from it.
It's like this big, relentless wave that you have to ride.
But in riding it, somehow you hold on to what you've lost.
And you find a way to go on without shutting off.
It's not easy, but you do it.
I know someday soon when you look into your child's eyes all you will see are the beautiful things that live on in him.
He needs to be okay.
I need him to be okay.
He will be.
He will be.
Based on his testimony, they don't have enough information to conclude - that he was mentally incompetent.
- Why is he here? - He's demanding due process.
- He needs to stay medicated.
I'll contact the convening authority to get him released from pre-trial confinement.
The door doesn't open from the inside.
Pick up the phone when you' re finished.
- You requested a court martial? - No.
- That's what the lawyer says- - I was gone less than 30 days.
The worst they'll do is discharge me, maybe a couple weeks' confinement.
You don't have a couple of weeks.
I haven't hurt anyone.
I haven't broken any laws.
I haven't acted irresponsibly.
- I just needed a change.
- You went AWOL.
That's between me and them.
They want me to say I'm crazy.
I won't say it.
- Nobody's saying you' re crazy.
- You are.
- No, I'm not.
- Come on, Abby.
You were there.
You even tried to hide it from me.
Mom was crazy.
She was out-of-her-mind crazy.
And I'm not like that! I'm not her.
You can say it all you want.
I'm not her.
Hey.
Shirley, she said she saw you out here on her break almost an hour ago.
You okay? No symptoms.
It's perfect timing, huh? You need something? I owe it to you to give you this in person.
Your evaluation.
- You' re not going to open it? - Open it for what? There's no middle ground with you, is there? - Blind optimism or self-pity.
- It's just the truth.
It's gonna cripple me.
Just when I learn how to deal with another symptom, it progresses.
- What were you expecting? - Time.
I expected time.
Enough time to figure out a Time's gonna kick my ass.
So, what, that's it? You' re just gonna give in? - Isn't that what you wanted? - No.
No.
I wanted you to recognize your limitations.
I thought you were trying to prove something.
But you probably saved that little boy's life today.
You connected with his father when he was completely lost.
You guided him to make the right decision.
Any idiot can suture a wound, put in a chest tube.
But you have a gift, Mr.
Nathan.
The gift of a physician.
Now it's up to you to decide if you want to share that gift.
And then find a way.
By the way, I keep my promises.
I failed you.
All they have is Diet Shasta.
- They still make this? - I hope so.
They might ask you to testify, you know.
Yeah.
Mom, I need you to be with me on this.
He can't stay in military jail.
I'm with you.
I'm sorry.
I'm just scared for him and I'm angry.
I'm angry at you for having to do this again.
- And you didn't do anything.
- No.
- You're angry at me for giving it to him.
- No, no.
I didn't- I know you feel like a mother to him.
Why shouldn't you? You practically raised him.
You have a right.
But I'm his mother and I gave it to him.
I gave it to my son.
All I can do now is try to be his mother.
- I'm sorry.
I gave his lawyer this number.
- I'm gonna try to find us a hotel room.
This may take a few days.
- Hello? - Hey, you turned on your cell phone.
- Hi.
- Well, did you find him? Yeah, I found him.
They might court-martial him, but I found him.
Did you tell them that he's sick? They already knew.
It's a long story.
- You still snowed in? - Oh, the city's a mess.
How are you holding up? - Do we have any spare monitors? - For what? - Fiber-optic otoscope.
- Oh, try Trauma Hall.
Good news.
Your appendix appears normal.
- No swelling or inflammation.
- Can she get something to eat? - She's getting her appetite back.
- A good sign.
- What do you feel like eating, Kiley? - Pizza.
Pizza.
That sounds good.
But you should have some soup until your tummy's settled.
All right.
CT's negative.
She can go home.
Drink some clear liquids, and come back tomorrow.
Excuse me, Dr.
Weaver.
- I never finished checking Kiley's ear.
- You don't have to.
We' re fine.
It's okay.
I'm not gonna hurt her.
- Can you help me? - Tell him we' re fine.
Don't worry.
She's safe.
I think I saw something, so I want you to hold the scope and put it in your ear very gently.
You even get to watch it on TV.
- Me? - Yeah.
You get to be the doctor.
- Is that my ear? - Actually, it's your eardrum.
- Gross.
- Use cotton swabs? - Yeah, every night.
- See, that's the problem.
The cotton swab rubs the protective wax.
It can cause an ear infection.
- And what can you do about that? - Well, I could give her some drops.
It's better if she never sticks anything in her ear smaller than her elbow.
- My elbow? I can't fit my elbow.
- You can't? - Mr.
Nathan, are you almost finished? - Yeah, almost.
- You' re needed upstairs.
- What is it? Field is dry.
Anastomosis site's intact.
You' re either gonna make me famous or get me arrested for cases like this.
Dr.
Nathan, Dr.
Carmichael.
I toil for eight hours, and you get the honors.
- Excuse me? - Over here.
Cardioplegia solution is withdrawn.
Okay.
Shut it down.
This is where you jump from the plane and hope you packed the chute correctly.
- Better grab those paddles.
- What? Paddles.
We' re gonna need them.
V- fib.
That's your cue.
Clear.
Heart rate, 70.
And that, my friends, makes it all worthwhile.
Start the epi.
Take down the catheters.
I guess his brother will always be with him.