ER s09e22 Episode Script

Previously on E.
R.
We're trying to travel to Matenda, but the main road is blocked.
You're going, right? To Africa.
I'm sorry, I don't speak French.
English? Long journey.
Yeah, I started yesterday.
Chicago.
Chicago.
Michael Jordan, right? Yeah.
You going to the Congo on business? I'm a doctor.
Where will you stay in the capital? Not staying in Kinshasa.
Going on to Kisangani.
Kisangani.
It's in the east.
A doctor in Kisangani.
You will be busy.
Very busy.
Mr.
Fitzgerald.
Mr.
Fitzgerald.
Taxi for Mr.
Fitzgerald.
Dr.
Carter? - Mr.
Joseph Solomon.
- Dr.
Carter? Dr.
Carter.
- Dr.
Carter.
- Hi.
John.
Charles Baruani.
You doing good, Dr.
John? - I could use a shower.
- Next plane is only three hours.
Not so much nice as last one.
Many amputees.
- Landmines.
- Machetes.
Is Dr.
Kovac still here? He's tall.
Croatian.
- Lots of black hair.
- Luka.
No.
All the ladies like Luka very much.
He's still at the clinic in Matenda.
Very dangerous place.
The Mai Mai fight there.
So we get mostly trauma - disease, malnutrition? - Yes.
Any one thing more than the other? Depends.
- On what? - The day.
Welcome to Kisangani, doctor.
You must be Dr.
Carter.
Angelique Chada.
I was coming to wake you.
I'm the on-site NGO physician.
You're a medium? You volunteered for an NGO before? - No.
Is Dr.
Kovac here? - Still in Matenda.
Charles tells me you don't speak French, so I'll get someone to translate.
- Need a coffee? - Yeah.
Now, it's pretty simple here.
Fever and a cough is pneumonia.
Use cotrimoxazole.
Fever and watery diarrhea is cholera.
Rehydrate and use doxy.
If the patient has a fever without sores, assume malaria and treat it with Fansidar.
If they have recurrent infections and are wasting away, it's AIDS.
- So prepare the family for death.
- What drugs do you have on hand? Amoxicillin, doxycycline, Fansidar - metronidazole, chloramphenicol.
- You still use chloramphenicol? - It's cheap.
- What about the aplastic anemia? Seventy-five percent of the children don't make it to age 2.
Aplastic anemia's the least of their worries.
For IV antibiotics, we have amp, gent and penicillin.
- Cefoxitin, unasyn, Cipro? - No.
- What do you do for resistant bugs? - Pray.
Take your meds, you should be okay.
If you get a fever, take Fansidar.
Gillian? Gillian Ronin, meet Dr.
Carter.
John.
Hi.
Gillian's an old hand.
She'll start you in Admitting.
- She seems great.
- She is.
- Where's she from? - Bombay, I think.
Been here six years.
- How many doctors are there? - Counting you, four.
Peter's our Congolese internist.
Deni is from Paris.
Angelique is our surgeon.
You already met Charles.
He handles logistic and supplies.
We have 200 patients on six wards and two surgical suites.
- How many nurses? - Five.
But the patient's family members do most of the work.
What? Nurses back home always complain about patient loads.
It's usually about eight.
Yeah, but I wouldn't use the conditions here as a positive example of anything.
- What ward is this? - This? This is Admitting.
Temp's 104.
Mom says she's got a headache.
No diarrhea or coughing.
Yeah.
She's a little jaundiced too.
Malaria it is.
So Fansidar? Yeah, two tablets.
This is gonna fix you right up.
- She doesn't get a bed? - For simple malaria, no.
Trouble with urination, fever and a cough.
His name's Saidi.
He's about 60 years too young for an enlarged prostate.
- Bladder's huge.
- Yeah.
- Foley? - No, manual compression.
Mild fever, 101.
5.
Any urinary-tract infections that local kids get? No.
Okay, tripod sign.
Okay.
Okay.
Okay.
Bladder paresis, tripod and head-drop signs.
- I'm sorry? - Poliomyelitis.
Without a spinal tap, we use the tripod and head-drop sign as diagnostic tools.
- He has polio? - Yes.
How's the jet lag? It's terrible.
That all you're having? I've had the food before.
Yeah, it lacks a little something.
Taste.
Anyway, I'm on a liquid diet consumed entirely after dark.
Where are you from? Your English is excellent.
Montréal.
We speak a little English up there.
How long have you been here? Ten days.
I'm a volunteer like you.
Come back for a month every year.
My penance, I suppose.
Penance for what? My wanton ways back in the world.
Hello.
Am I interrupting, or can anyone drop in? You're not interrupting anything yet.
You two do know that I'm sitting right here, right? She asked how you're doing, and I said great.
And that you'll be just fine on your own this afternoon.
- So where are you from? - Chicago.
I work with Dr.
Kovac.
He called me when you got short-handed.
And I'd been thinking about volunteering.
Luka? What's he like at home? I should get back to work.
Luka took an immunization team out to Matenda three days ago.
We don't get vaccines often.
When we do, refrigeration is a challenge.
So he grabbed a team and went.
When do you expect him back? Yesterday.
It happens.
He's had fever for a week.
Rhonchi and retractions.
Tell her that he has pneumonia and that we'll make him better.
IV ampicillin.
You're welcome.
Hi.
Who's sick? You or? - Basinake.
- Yes, doctor.
This woman is dead.
I know.
She has been very ill.
Why didn't you tell us she was so sick when you came in? She has had AIDS for many months.
I did not know where else to go.
How is Fazila today? She's in pain, doctor.
Tell her that I'm sorry that it's so painful but I need her to be brave like I know that she is.
Okay.
Bonjour, Ntam.
Oh, great.
Power out everywhere? There's only one line from the turbine in the river to town.
Mai Mai cut it every couple of weeks.
- How are you finding it here? - Busy.
No insurance forms, no triple-charting.
I love that.
No healthcare system.
I wouldn't mind filling out a few insurance forms if it meant I could have an ultrasound.
Charles! Boy up front has a gunshot wound to the left upper quadrant.
This one is a machete wound to the right thigh.
Lots of blood loss.
Charles, start the generator! Where are Peter and Deni? Send someone to find them.
Small-caliber wound to the belly.
Pulse is 120.
BP, 80/60.
- This water's cold.
- You want to wait for someone to boil it? Luka, take the hack wound.
I'll explore the neck.
Dr.
Carter, see if you can discover what's wrong with this last one.
- Where are the gloves? - In the basin.
Right over there.
Got a weak carotid, and he's tachy.
- How do you stabilize the neck? - Sandbags.
- Who's he? - Says that he's the brother.
He wouldn't let us leave without him.
- Give me a 7.
5 ET tube.
- We don't have ET tubes.
I can bag him.
Great.
Ask him what happened.
I don't see any blood.
He's bleeding somewhere.
Belly's hard.
Is he Mai Mai? - Yeah.
- I got a foreign body under the skin.
He says a bee flew into his brother.
His brother fell.
Femur deformity, closed fracture.
- What? - A bee flew into him.
A bee? Entrance wound to the right axilla.
Bag him on 15 liters.
Make it two liters, or we'll run out of oxygen.
GSW to right axilla, bullet in the thigh.
- An hour isn't enough time.
- Unplug every light.
- How much time will that get us? - Four hours, maybe.
BP's 90/60.
Pulse 130.
Pulseless foot.
Get his pressure up with two liters.
Got a transthoracic GSW.
Bullet entered the armpit dropped a lung, traversed the belly, ended up in the thigh and broke the femur.
- Abdomen's stiff.
Betadine.
- Gonna need a chest tube, maybe two.
Got peritoneal signs.
Positive DPL.
Where's the bullet? Left anterior thigh.
You don't need a DPL.
He meets criteria.
- He needs an e-lap.
- Knife.
He's Red Cross category four.
Waste of resources.
Hand me that.
There.
Least of his problems are solved.
Full-jacketed 7.
62 mm with full rifling grooves.
A Dragunov rifle.
His pressure's holding.
Dragunov's muzzle velocity is 830 meters per second.
It can kill from over half a mile away.
Closer, it does more internal damage.
So we're just gonna let him die? If I take him, he'll need five hours to stabilize.
He'll probably die anyway.
I have four hours of generator fuel and three injured boys I can't fix before the power goes out.
Keep him stabilized.
If the lights are still on when I'm finished, I'll come back.
Have you ever done an end-to-end anastomosis? - No.
- Well, now is as good a time as any to train you as a vascular surgeon.
Anchor with an overhand hitch, give gentle traction.
- How much longer? - I don't know.
Still working on the last one.
We need more blood.
That's the second unit.
I'm O-negative.
I could donate.
- You can't save the world.
- Is that why you're here - working at the Ritz? - Me? I'm in it for the money.
- Charles? - I thought we had another hour.
It's the roll.
- What? - The roll.
They roll the generator fuel tank when it gets near the bottom so they can squeeze out every last drop.
Makes the lights flicker.
Last of the 6.
0 Prolene.
Unclamping the femoral artery.
- Got a pulse in the foot.
- Good.
Pack it and leave it open.
Still alive? Barely.
Prolonged hypotension.
Could be ischemic.
How much time do we have left? - Half an hour or so.
- Charles? Okay, let's see what we can do.
Release pressure.
No bleeding.
Let's pack in there with some more lap pads.
Come on.
We're out of lap pads.
I've got another five minutes in the sterilizer.
Here.
I'm losing track.
What else? Liver, spleen, removed a wedge of lung.
Repaired the renal vein.
The diaphragmatic repair, then run the bowel.
- Run a V-tach.
- A hundred lidocaine, start a drip.
- Two mgs per minute.
- Duodenal hematoma.
Stapler.
You're gonna staple a duodenum? Faster than sutures.
Okay, drip is 100 and 500 at 10 drops per minute.
Okay, I'm gonna run the bowel while you do the diaphragm.
That's it? Leave him open.
If he survives the night, we can repair the bowel in the morning.
- There's fecal matter in here.
- It'll have to do.
Pack it.
Then tape.
Lots of tape.
He's oozing from his fingertips.
Is it DIC? - Blood around the gums too.
- Are those clean lap pads done? - I can't get a pulse.
Irregular.
- Come on.
- Lost it.
- All right, I'm pulling the tape.
Dr.
Carter.
I can't find the heart.
All right.
There it is.
I got it, I got it.
Starting compressions.
No pulse, no pressure, no resps.
He just needs more volume.
Leave him be.
Let him be, doctor.
Tell him I'm sorry.
He knows.
I didn't know you smoked.
I don't.
When'd you get here? Six days ago.
How much longer are you staying? I don't know.
I'm going back to the clinic tomorrow.
I have patients who can't be moved.
I came back for some supplies.
Welcome back.
Thank you.
I thought you might be upset about that boy.
I'm okay.
I'm exhausted.
I'm going to bed and I hope someone will join me.
How's Abby? I didn't do anything with Gillian, I swear.
So you won't mind if I? No.
Knock yourself out.
See you in the morning.
She took the pills, but the fever came back.
The Fansidor isn't working.
Her malaria has advanced.
IV quinine, 10 per kilo every eight hours.
John? Meet Drs.
Thorpe and O' Brien.
Americans fresh off the plane.
- Damn, it's hot.
- Actually, we got a breeze today.
- Gillian? - Yes.
Finish the tour, start them down in Triage.
Sure.
Welcome.
What are you doing tomorrow? Is that a trick question? Charles brought vaccine on the plane from Kinshasa.
Road is open, but who knows for how long.
Thought you might assemble an immunization team, see the country.
- Yeah.
Where would we go? - Matenda.
But you'll have to find a nurse who's willing to go with you.
and work in Admitting.
- Who are they? - Interahamwe, Hunde, Banyarwanda.
Hard to tell anymore.
Everyone fights everyone else now.
FAC.
Government's army.
I grew up near here.
Everyone was very happy.
It was beautiful.
I wish you could have seen it then.
- Good trip? - Slow.
What'd you bring? Polio, DPT, MMR, supplies.
What are all those people waiting for? You.
How do you say, "Don't be afraid "? Well, something like that.
- She's laughing at me.
- Your French is terrible.
See? Didn't even hurt.
Gillian, ask him how long his son has had this cough.
About two weeks.
Do we have any erythromycin? Only amoxicillin and ampicillin.
Pertussis? Yeah.
Tell him that his son is sick and we're gonna give him medicine, try to make him feel better.
Sounds close.
Yeah.
A mile, maybe two.
Pertussis They don't have anything stronger than amoxicillin.
Did you tell that boy's father we could save him? We can.
Whooping cough's gonna eat that amoxicillin for lunch.
He's gonna die.
Die from a disease we could wipe out with a $10 course of erythromycin.
We vaccinated 200 children today.
When was the last time you saved Would you like a drink? Willie Nelson? Charles went to college in Texas.
Dr.
John, get down! Get down! Luka! Foot's missing above the ankle.
Get a BP cuff.
Foot's gone.
We have to operate below the knee.
- Do we have any surgical equipment here? - No.
- What about anesthesia? Ketamine? - Only lidocaine.
Okay.
We need to do a Bier Block with lido.
Gillian.
- Yes.
- Start an IV in the popliteal.
Somebody please get this poor girl's mother away from here.
Charles, get a suture kit and the biggest knife you can.
And a saw.
We're gonna need to sterilize some sort of saw.
- What's her name? - Chance.
Chance She's unconscious.
Okay, skin's good below the knee.
Tie off the bleeders.
I need the flashlight closer.
They are fighting! They are coming this way! - We need to evacuate the patients.
- Where? - Into the old plantation.
- Go! Go! There's another bleeder.
- I got it.
- Got that one? - We should go.
- Not yet.
They're getting too close.
Got that one? - Luka, we have to leave her.
- No.
- Saw.
What do we have for a saw? - Betadine.
Okay, hold it steady.
Okay, I'm through.
Moist dressing.
Okay, let's go.
How's her pulse? Strong.
Regular.
If there's no infection in four days, I'll revise it and clean up the flap.
The skin looked good.
Should make a nice seat for a prosthetic.
That was impressive.
Looked like you did it before.
I have.
In the beginning, there's a lot of talk of national pride and patriotic speeches but after a few weeks, it becomes this.
Nothing but death and sadness.
These people just want what everyone else wants.
Their kids to have something to eat, to see them grow up laughing, happy.
They don't care where the border is or who gets to call themselves president.
Just want this to stop.
I don't even begin to try to understand the politics here.
You're an American, Carter.
You believe if people are given the chance to convert to democracy - the world would be a better place.
- What's the alternative? Military dictatorships? You fight wars from the sky with bombs and missiles.
Then your planes land back on the aircraft carrier and the pilots watch Drew Carey on satellite TV.
Hey, American soldiers died in Iraq.
Yeah, but your children don't starve to death while your men fight.
Your women aren't raped.
I remember watching the television, reading the newspapers certain that we had to fight.
And then my family was gone.
I couldn't remember why it was all so important.
What difference did it all make? My children were dead.
Yeah.
One is still alive.
Bring him in.
The food's gone.
Some supplies.
- Where do you want him? - Right here.
Gillian, need another IV ampicillin and whatever we have for pain.
- Okay.
- FAC.
A government soldier.
Carter? Small-caliber GSW to the right upper thigh.
He is pale and diaphoretic.
Lost a lot of blood.
He's not really improving.
You wanna try penicillin? No.
Stay with the amp.
No sign of infection.
Yeah, that looks good.
- What's his problem? - Wants to get back.
He's afraid to stay.
- Does he know where the army is? - I don't think so.
Dr.
Luka.
Tell him as soon as he can walk, he's free to go.
- I have patients who can't be transported.
- The fighting's heading back here.
Angelique wants to abandon the clinic until it's safer.
Roads open again? We think so.
A UN food truck got through today.
We move them, they'll die.
- How many? - At least three.
Listen, take everyone else, leave supplies and come for me in a few days.
- No, I can't.
- I won't leave my patients.
I'll try to reach Angelique on the radio.
- I can stay.
- You want me to stay too? - No.
No, please.
- I will.
Take Gillian.
Make sure she gets back safe.
What was that all about? Road's open.
- You'll need help.
- Patrique is staying.
He has no medical training.
You cannot take care of three critical ill patients alone.
- Of course I can.
- Oh, yeah? How are you supposed to do a Bier Block on that amputation without a nurse? - You're not staying.
- It's not your decision.
- You're getting into that truck and going.
- No, I'm not.
It's only for a couple of days, then you'll come back and get us.
- Is it Mai Mai? - Yes.
What's he saying? That you tried to save his brother.
That you tried for a long time.
Hello.
Hi.
You're welcome.
So, what should I tell Weaver? Whatever you want.
Can I tell her you're coming back? I don't know.
Don't do anything stupid.
- Like what? - Like get yourself killed.