ER s10e06 Episode Script
The Greater Good
E.
R.
Previously on E.
R.
Sam Taggart, new nurse.
I started my Surgical rotation today.
I'm back in med school.
- So no more nursing? - No.
I'm still gonna be taking a few shifts for a while.
I need the money.
What are you nutmeats doing? Clearing Triage.
We'll provide good care, and we're gonna do it faster.
We're gonna form a line down the hall, and you'll be examined three at a time.
- Is this your new hospital? - Yep.
It's even crappier than the last one.
I'm a 71-year-old man who's going blind.
I've considered everything.
I need you to promise me you're not gonna kill yourself in the next 72 hours.
But Monday would be okay? I'm off the hook by then.
E.
R.
10x06 "THE GREATER GOOD" "The friend had, in a weak hour, spoken with sobs of his own death.
He had delivered a melancholy oration previous to his funeral and had doubtless in the packet of letters presented various keepsakes to relatives.
But he had not died and thus he had delivered himself into the hands of the youth.
" Oh, sorry.
Are you taking your enalapril? - Yeah.
- Want me to bump up your Lasix? Coffee does the same thing.
It also raises your blood pressure.
Well, as luck would have it you gave me a pill for that too.
You want more espresso? Not unless I'm gonna fly to work.
"The latter felt immensely superior to his friend but he inclined toward condescension.
" You don't have to keep doing this.
Well, I've got time to finish the chapter.
I've never read this before.
It's good.
You don't have to keep coming here.
I don't have this book.
Keep it.
I'm I'm never gonna read it again.
That's why I'm here.
That and the coffee.
He died at 29.
Stephen Crane.
TB.
Just a little trivia.
Nice.
Very cheery.
"He adopted toward him an air of patronizing good humor.
His self-pride was now entirely restored.
" I like this place already.
Don't think they give away free doughnuts every day.
- Bars give away free peanuts.
- So you get thirsty and buy more beer.
If they gave away doughnuts, people would buy more coffee.
Please! Can you help me? I think I'm having a miscarriage.
- How many weeks? - Twenty-four.
- First pregnancy? - First one to last this long.
Oh, she's adorable.
I found six behind my apartment.
She's the last one.
- They don't allow pets in my building.
- They're not allowed in here either.
- Hey, buddy, want a doughnut? - Frank! What? Dogs love doughnuts.
Want a pooch? Free to a good home.
Dogs irritate my asthma.
Hi, I'm Terra King from Ladokern.
I have gifts and snacks for the Residents.
Is there some place I can set up? Lester.
Lester, can you take care of this, please? - What's wrong with him? - Come on.
Punch it, Cat Daddy.
- What are you guys watching? - Carjacking.
Pratt.
Needs to get on Lower Wacker to lose the chopper.
This is Denny.
Vaginal bleeding at 24 weeks.
Can you take her? - Sure, sure, let's go.
- Cheering for the carjacker to get away? No, we just want him to get a few more blocks.
South of Van Buren he's out of our catchment and goes to Mercy.
- If there's a crash - There's always a crash.
Turn left.
Get on the expressway.
- Yes, yes, go, go! - Go, go, go! - Damn it.
- That's gonna hurt.
You have friends downstairs but you can't let them take advantage.
- The patient was borderline.
- Precisely my point.
He needs to stay in the ER.
If his condition worsens, I'll go back down.
You know they're only too happy to free up beds by dumping patients onto Surgery.
Dr.
Corday, they need you in post-op and the ER is calling for a gallstone consult.
All right, you go down there, make your assessment and call me.
Be strong.
Colles' fracture.
Put on a sugar-tong splint and have him come back for casting after the swelling goes down.
- Vicodin for pain.
- Wrist film? It's not deformed.
Distal neuro-circ intact.
We'll get an x-ray when we cast.
Malik, get six units of O-neg down here before the car crash starts rolling in.
- Already ordered eight.
- Tell me about the gallbladder.
Fat and 40 with a history of gallstones.
I gave her a shot of Toradol.
She's afebrile.
Abdomen is non-tender.
- Good.
Send her home.
- No ultrasound? No.
No labs, no IV, no x-rays.
Tell her to stick to a low-fat diet.
- How'd you do this? - I was using a utility knife to open a box.
Be more careful.
Keep it clean and dry.
Come back in two days for a check.
- What's this? -24-year-old female, bladder infection - positive for leuks, ICON is negative.
- I ordered Bactrim and Pyridium.
Good.
Tell her to pee after she has sex.
It's a good way to prevent UTls.
Coop, your subconjunctival hemorrhage probably happened from sneezing and it will get better in a week.
Reassure your patient that he won't go blind and get him out of here.
Five patients in two minutes.
That's a record.
Make sure you're not skimping.
- Skimping? - Yeah, on the billing.
- Check off a few more boxes next time.
- I won't bill treatment we didn't provide.
It's called capitalism, Kovac.
Pays your salary.
Okay, there's the heartbeat.
Amniotic fluid index is good.
Excellent fetal movement.
- He's good? - Yeah, but you're dilated 3 centimeters.
I've already had two miscarriages.
I was supposed to start bed rest next week.
I can't go through this again.
I'll give you some medicine to stop you going into labor.
Junior needs a few more weeks before he's done.
Let's start with 0.
25 of terbutaline sub-Q and give 4 grams of mag.
Here, magnesium might make you a little queasy.
I'll be back in a few minutes to check on you, okay? Hey, Jerry, what's the ETA on our car crash? Two minutes and counting.
- Can I present a patient? - You better make it fast.
Woman, 23, sudden onset occipital headache, grade eight out of 10.
- Worst headache of her life? - Close.
- Thunderclap onset? - Two minutes.
No history of migraine.
Neuro exam is non-focal.
Okay, get a head CT, and rule out subarachnoid hemorrhage - and get 10 of MS for the pain.
- Thanks.
Kevin Dunn, 32-year-old driver, high-speed MVA with prolonged extraction.
- Jacker or victim? - Jacker.
Victim's behind us.
Lap belt.
Front impact.
BP, 104/84, pulse 106.
- Creamed the next guy real good.
- We were watching.
Should have turned left on Stanton.
I would have got away if that jerk didn't cut me off.
Oh, looks like a big flail segment and closed clavicle fracture.
- Put him in Trauma 2.
- Driver numero dos.
Thomas Collins, victim.
High-speed restrained impact with head injury.
Turn him, turn him, turn him.
Let's go.
Come on.
Come on.
I put Mrs.
Walters in Exam 2.
She needs a little TLC, maybe some Zoloft.
That makes two of us.
Look at them.
They are like kids in a candy store.
One hospital I worked at tried to ban drug reps but Residents complained.
They like the free food.
- How they hook you.
Food, equipment- - Oh, don't forget the boobs.
I imagine they have to pay for those.
Keep Kovac away from her.
He's been known to give away free physicals.
Okay, Ernie, where were we? I got worms.
- What the hell is this? - Looks like a hospital bill.
- Accounting, fifth floor.
- They wouldn't help me.
- Well, I can't either.
This is the ER.
- All right, Ernie, those are maggots.
- When's the last time you changed that? - Look, look, I was already there, okay? I sat here for 11 hours with my sick kid to have some quack tell me it was a virus and he'd get better on his own.
Did he? They didn't do anything for him and I get a bill for over 2 grand.
I wanna see the doctor who stiffed me.
- Carter.
I wanna see this Carter guy.
- He doesn't work here anymore.
- Come on! - Here's what we're gonna do.
I'll fix you up with a nurse, something to eat and a bath.
But your friends there, they gotta go.
- I want this fixed! - I wouldn't do that, sir.
Are you gonna do something about this bill? Are you gonna get off your ass? No.
But he is.
- Dr.
Kovac.
- Zack Isley, 6-foot fall into gravel no LOC, GCS 15.
Superficial lacs and abrasions on head and right upper extremity.
- Complaining of right shoulder pain.
- Hey, Zack.
Dr.
Kovac.
What happened? Just goofing around, took a header.
Can you straighten your arm? Okay, Curtain 2.
- I just sprained it.
- Why don't you let me decide that.
We'll get you an x-ray.
Clean those cuts and scrapes.
- Might even need some stitches.
- Really? Don't worry.
We'll numb you up.
You won't even feel it.
- No, no medicine.
I can take it.
- Tough guy, huh? Trauma panel, a clot, lateral C-spine, chest x-ray and AP pelvis.
Poor guy's driving down the street, minding his own business, then: - Wakes up in the ICU.
- If he wakes up.
- Can't see the pupils, too much blood.
- Laps and saline.
Chest is clear.
- BP is 140/94, pulse 72.
IV is blown.
- How are we doing in here? Well, he's gonna need to be tubed but we got it covered.
Thanks.
Abby, can you start an IV? Nurses start IVs.
Surgical students do cutdowns.
- Spank them, Abby.
- Somebody get me a central line kit? Yeah, I'll send one back.
On the monitor, BP's 106/80, tachy at 111.
- Triple lumen kit next door.
- I can't see into his airway.
- No blood in the nares or around mouth.
- SonoSite for Dr.
Cooper.
Pain meds on the fly but let's complete the survey.
Decreased on the left.
Sterile gloves, please.
BP's 104/86.
Sats 92.
All right, kids, you're on.
Show Dr.
Chen what you know.
Free fluid in the abdomen and pericolic gutter.
Try there.
You could use a little more jelly on your belly.
- You're the Attending.
- And in Morrison's pouch.
- Meaning? - Intra-abdominal injury secondary to high-speed mechanism.
Needs O.
R.
Start the chest tube.
I'll be right back.
Don't be a stranger.
- Guy next door needs a surgeon.
- I'll call Corday.
Mommy, come save me.
I'll decide if he needs surgery.
- He only responds to pain.
- Urine output's good.
Okay, laryngoscope.
No, no, Surgi-Girl, go next door.
Start the workup.
- Yeah, I was gonna intubate.
- Next time.
Now.
Go, go.
Get me a staple gun so I can put this guy together.
- I feel the inside of the chest wall.
- Surgery.
Hello, surgery.
Abby, can you turn that damn thing off? - Yeah.
- Okay, lead the guide finger in with the other hand, slide the tube through.
- Got it.
- Sats are up 98 percent.
- Thanks.
Nice job.
- Okay, Abby, give me the bullet.
I was trying to fix the monitor, sorry.
Oh, you're a med student, a nurse, and technician now.
What's next, cowgirl? I'm pushing the drugs.
You want this or not? - Yes.
- I told you to evaluate this guy.
- I can do it.
- I don't care who does it.
Neela, go with Dr.
Pratt.
Come back and sew these in when you're done.
Well? No fracture or dislocation.
You probably just strained the ligaments a bit.
- Told you.
- Maybe you should be a doctor.
Yeah, not with my grades.
I wasn't a great student at your age.
I almost failed lunch.
- Sorry.
- Kovac, this guy's here for your patient.
Ron Kennedy, I'm a social worker from Stadler House.
We're a foster care facility.
Zack's one of our residents.
- You mean prisoners.
- Relax.
I'm his caseworker.
Zack hopped a fence on an outing and ran off.
I escaped, you Nazi.
- Call my mom.
I'm not going back.
- Zack has a conduct disorder.
- Screw you! - Could you give us a moment? - I think he's off his meds.
- Back off, man.
- Hey, stop it, Zack.
- He needs Haldol.
- Go back to the waiting room.
- Get the hell out! - Get back in bed, Zack.
- He needs to be sedated.
Out! Hey.
I'm not going back there.
Please, don't let them take me back.
Please.
- Third crit is down to 29.
- Done.
Let's roll.
Call Corday, and tell her I'm sending her up a gift basket.
Looks good, but if it comes out, you owe us a beer.
I'm more a cosmo girl.
- Drink or magazine? - A little of both.
- Did Neurosurgery agree? - Yeah, diffuse axonal injury.
No operative lesion.
They'll sign off after the second test.
- He's brain-dead? - Yes.
Bad guy gets patched up, victim is a vegetable.
Haven't saved this guy yet.
Change that dressing.
- Which O.
R.
? - That's not your business.
Call UNOS.
Your butt's down here until the coordinator arrives.
You wouldn't feel it if you let me use just a little analgesic gel.
For six months I've been on Tegretol, lithium, Risperdal, clonidine Benadryl and Klonopin, okay? I've been so doped up I didn't know the day.
- Have you been cheeking your meds? - Had to.
- It's the first day I felt normal in months.
- That why you ran away? I got tired of being a freaking zombie.
- Did you call my parents? - Your mom's on her way.
You're not gonna let them take me back, are you? We'll talk about it when your mom gets here, okay? Hey, Pratt? - This scan's negative.
- Yeah.
I'm still waiting on a Neurology consult to evaluate a possible subarachnoid.
- Do an LP.
- They'll be here any minute.
You're wasting time and resources.
What's his problem? Besides being tackled in the waiting room? Possible new onset angina.
I've ordered nitro, CBC, chem panel, serial troponins and a chest x-ray.
And I'm still waiting on Cards.
- EKG's normal? - Yeah.
- You smoke? - No.
Hypertension? - High cholesterol, diabetes? - No.
I'm healthy.
I run about 12 miles a week.
Okay, let me guess.
The pain started after your incident in the waiting room.
Yeah.
It's an anxiety attack.
- Over this stupid hospital bill? - Probably.
Let me see it.
What's the complaint? My kid came in with a fever.
Your son didn't need that.
Certainly didn't need chem panel and two sets of blood cultures.
You should have only been charged for, what? Three hundred dollars.
Thanks.
Hey, Slavco.
What do you think this is, some Zagreb Yugo dealership? On the occasion we do get a patient with insurance, we don't give them deals.
I expect that kind of idiocy from Pratt, not from you.
I thought I was his favorite.
Hi.
I'm Terra King.
Have you heard of Quinamax? It's our new once-a-day antibiotic with excellent coverage for bronchitis and otitis media.
Neither of which needs treatment with antibiotics.
It has great gram-positive coverage, making it ideal for cellulitis.
I have a patient coming in at 3, Ben Hollander.
When he shows up, just let him in and come find me, okay? Sure thing.
Hey, what's up? I got a 27-year-old G3P-zero history of cervical incompetence, EGA, 24 weeks.
Presented in early labor cervical dilation progressed from three to six on terb and mag.
- Fetal distress? - No.
Looks good.
- Heart rate's in the 160s, good variability.
- Can you repeat the terb? No.
We're maxed out, and she's tachy.
Send her up to Labor Delivery.
Have a Pedes resuscitation team standing by.
If she's progressing on tocolytics, there's nothing we can do.
She's revealing both her upper and lower teeth when she laughs.
- What? - Chen.
It's a sign of flirting.
There.
Hair touching, another one.
Get in there before it's too late.
What are you talking about? I was a cop for 25 years.
You learn body language.
Look at that.
She's mirroring his motion.
Twenty bucks says she touches him next.
So what? She slapped him.
First it's a slap, then it's a tickle.
Before you know it, she'll be spanking his ass.
Jerry, can you call up to L and D? Tell them to make sure- - I need to find a fire hydrant.
- Hey, that's a cute puppy.
Can I hold it? You can have it.
Forty-three-year-old man with left flank pain radiating to the groin.
Denies fever, vomiting.
Exam's notable for CVA tenderness on the left.
- Urine heme-positive.
- Okay.
Diagnosis? - Kidney stones.
- What else? CBC, chem panel, and CT urogram.
- Okay.
And give 30 of ketorolac IV push.
- No.
No CBC, no chem panel, and no CT.
You don't even need the damn IV.
It's expensive and takes up nursing time.
Give him 60 of ketorolac IM and a bedside ultrasound to rule out hydronephrosis.
- You won't see where the stone is.
-90 percent of cases pass on their own.
- He's afebrile, and his UA is negative.
- And if it's too big to pass? It'll cause hydronephrosis, and he'll come back.
He still thinks he's in the Congo.
Get the CT.
You need to take him up.
That's not how it works.
I come down, I see, I present.
I know how it works.
I'm telling you as a surgeon and head of ER take this guy to your service.
Do I need to write you a damn note? "Dear Dr.
Corday, please admit Abby's patient.
He's very sick today and requires an ex-lap before he gets septic and dies.
" - You hanging in there? - By a thread.
- Dr.
Lewis, can you help me? - Sure.
Which patient? It's about the doctors.
I'm getting conflicting advice from Pratt and Kovac.
Welcome to County.
- Kovac is the Attending.
Pratt isn't.
- Abby.
This is Patricia Collins.
- Husband was involved in the car chase.
- Oh, I'm sorry.
Hi.
Abby Lockhart.
- I'm Neela.
- Hi.
I worked on your husband.
You'd like to see him? - Yes.
- I'll take Mrs.
Collins in while you're waiting for the UNOS team.
This way, please.
- I'm beginning to hate her.
- She's a med student.
I'm a med student.
Now that you mention it, she's pissing me off too.
Come on, let's hate her together.
Now, the medicine I gave you hasn't stopped you from going into labor.
Your contractions are increasing in frequency and your cervix is continuing to dilate.
My husband had to go to Seattle for work.
He didn't want to go, but I said, "Don't worry, I'll be fine.
" I can't believe I'm having another miscarriage.
No.
You're not miscarrying, Denny.
You're gonna have this baby.
I'm sending you up to Obstetrics.
They're set up to handle preemie delivery.
I don't want a preemie.
Our NICU cares for babies like this all the time.
Yeah, babies with brain damage.
My sister-in-law had a preemie.
They spent every day in the NICU and it still died.
- This baby has a chance.
- I don't want it this way! Okay.
Okay.
Problem? She doesn't wanna have the baby.
- She's 24 weeks.
- What's the weight? Five hundred twenty grams on the ultrasound.
Twenty-four weeks, over 500 grams? That's the hospital's viability threshold.
We're gonna spend half a million keeping one baby alive while we shut down the lead eradication program? I've admitted three kids for chelation this week.
Why stamp out lead poisoning? Just shoot your wad on a little gorker who can enjoy a lifetime of special ed.
What am I supposed to do? Mom doesn't want to save this baby.
She doesn't have any rights.
If it's over - Aren't you on a surgical rotation? - Yup.
- Then rotate.
- What's the kid's chance of a normal life? - Ten percent? Less? - It's hospital policy, Luka.
- Change the hospital.
- Another good idea.
Let's send her to Santa Niña Muerta Hospital.
It's called natural selection.
Heard of it? It's worked for a few million years.
So tell me, what should I do now? Hospital policy exists for a reason.
First learn the rules, then learn when to break them.
What's in her best interest? The laceration is superficial, and his shoulder is only bruised but I do have some concerns about the medication he's on.
- Zack's had some problems.
- Had.
I'm fine now.
I think he may be overmedicated.
They told me that was for his own good.
I had a drug problem.
I let him run wild.
And then he was always doing this crazy stuff.
- He got into fights.
- It's called self-defense.
- He stole a car.
- One time.
I'm not doing that anymore.
They blamed it on me.
They said I was an unfit mother.
Do you have custody? Not at the moment.
- Has Ben Hollander shown up yet? - Not that I've seen.
Can you look at a possible scaphoid fracture in Exam 3? Yeah.
Hold on a second.
Mrs.
Collins refused to donate her husband's organs.
I've heard minority families seldom agree to organ donation.
What, did you just let her leave? I told her she could sit with the body until he went up to the ICU.
I'm looking for Dr.
Pratt.
Greg.
There he is.
It's 2003.
He doesn't have an answering machine.
He promised me.
We have a therapeutic contract.
Look, I'm sure he's just running late.
Maybe he stopped to get a coffee or Jump off a bridge? - Hi.
From Neonatology? - Yeah.
Vargas.
Where's your patient? Her name is Den- - Hey, Lily, where's Denny? - I haven't seen her.
- Can you check the bathrooms? - Sure.
Just give me one second, all right? I'll find her.
- She left.
- Who? My pregnant patient.
You talk to her? - No.
- Well, she took your advice.
She eloped.
That was always her prerogative.
- I need a doctor out here.
- Doesn't mean it was the best thing for her.
- You're supposed to be teaching me.
- I'm trying, you're not listening.
Some lady is in the back of my cab.
I think she's bleeding to death.
Denny, what happened? I tried to make it to Saint Joe's but the baby's coming.
- Is she dying? - No.
Run inside.
Tell them I need a gurney and a BOA kit.
- Go! - This is in her best interest? She wouldn't have left if you'd done what she asked.
Type and cross Mom for four units, two large-bore IVs and a liter of LR running now.
It's too soon.
All right, Denny.
One big push.
Let the NICU know we've got a 24-weeker on the way.
- Come on.
Cord clamp.
- Please, don't save him.
- It's a boy.
- Eyelids are still fused.
Let him go.
I asked for two lines.
Who's working on the second IV? - Come on, we need access.
Let's go.
- Full respiratory effort.
- Placenta's delivered.
- I don't want this baby.
Bleeding's picking up.
- Heart rate's in the 130s.
- Yeah, uterine atony from the tocolytics.
Run in another liter of LR and 20 of Pit.
- Do you have a pulse? - Slow, under 100.
- Start compressions? - Bag him up first.
No, you need to weigh him before anything else.
Less than 500 grams, we stop.
Draw up some epi, get ready with the tube.
Do not tube that baby until you get a weight.
You hear me, Pratt? I mean it.
- No tubes, please.
- Five hundred and six.
- No.
- Pratt, she doesn't want this.
- I'm following hospital rules.
- Doesn't make it right.
- This kid is alive.
- Systolic's down to 78.
and rush the blood bank.
All right, I'm in.
Bag him and give You got it.
Mrs.
Collins, can I get you anything? Or anyone I can call? Tom's sister is coming.
She wanted to say goodbye.
Sorry.
Shouldn't be doing this, Pratt.
She has the right to demand a natural death.
We have a family room.
If you'd like to wait for your sister-in-law in there, it's a little more quiet.
- I wanna stay with him as long as I can.
- Okay.
What's happening? They're trying to save a premature baby.
We just started trying to have kids.
Mrs.
Collins, did Neela talk to you about recovering your husband's organs? I told her I didn't want that.
He's been through enough.
Why? Does he have something that could help the mom or her baby? I don't know.
Maybe.
But there are lots of others who would benefit.
Tom was always going out of his way to do stuff for other people.
To the point where they would take advantage of him, but he didn't care.
I would always tell him, "Don't you know nice guys finish last? " He would always say: "Guys who finish last are nice.
" He was so stupid.
What would they do if he was a donor? The recovery team would take him to the ICU.
And they run tests, and they start matching his organs - to people who need them.
- Like his kidneys? Several organs can be recovered.
He could help as many as 50 different people.
Tom would like that.
What all will they take? Well, his kidneys which would go to two people with end-stage renal disease and that would free them from a lifetime of dialysis.
Ben Hollander, Susan Lewis.
No, I'm the doctor.
He's my patient.
County General.
Okay, then I'll talk to the watch commander.
My mom around? - In a trauma.
Wait in the doctor's lounge? - No.
You get any freaks in here today? Guys with Elephant-Man disease and axes stuck in their head? - No.
- Should you be looking at that? I'm gonna become a doctor.
Dollars to doughnuts that kid is already dissecting the neighborhood pets.
When you put me on hold, you increase the chance he's in trouble.
- Sure.
- Hey.
You wanna see a puppy? Why? I don't know.
Because she's cute? Where's the morgue? Your mom says we aren't allowed to let you go there.
I'll give you 5 bucks.
- That kid ever give you the creeps? - He's right at the age where it starts.
Teen rebellion? Devil worship.
Keep an eye on that puppy.
Never mind.
- You were supposed to be in hours ago.
- Oh, I'm sorry.
Oh, these are- These are for you.
Sort of a peace offering to make up, you know, for my tardiness.
You didn't have to do that.
Well, there's a guy outside, you know, selling them on the street so it's, you know, no big deal.
Oh, and I I brought you this.
We're not finished reading it.
Well, you know, I know how it ends.
Lily, can you set Ben up for a blood draw? Sure.
This way, sir.
- That patient brought you flowers? - And a book.
He's a Civil War buff.
I've been reading to him.
He's losing his sight.
You're going to his house? Yeah.
The guy was a possible OD on Dig a couple weeks ago.
I'm still not sure it wasn't attempted suicide.
Wanna make sure he's reengaged before I cut him loose.
This is a first edition.
Sounds like he's engaged with you.
He has no one.
He's going blind.
He sacrificed everything for his career and now he has nothing.
No one should end up like that.
- Where the hell is OB? - Paged them three times.
Denny, stay with us here.
- EBL 1500 cc's.
- I'm hitting resistance.
When it bounces back, you're in the liver.
Thread it again.
- Get him upstairs, Pratt.
- Kovac, I need to talk to you.
- Kind of busy.
- What's the holdup with that kid from Stadler House? They're threatening legal action.
- Still waiting on a Tegretol level to- - No, you're not.
It's back.
He can't go back there, Kerry.
Their treatment program is keeping him so drugged that he can't think straight.
- BP's up to 98/55.
- Good.
He's a nice kid.
You know better than the psychiatrist who's been treating him for two years? - She has too many patients.
- She also has privileges in this hospital.
She's on her way to administer Haldol because the ER physician refused.
Everybody's so concerned about the rules and policy they forget there's a kid caught in the middle.
Reform the foster-care system on your own time.
Neela, come with me.
- Discharge this patient.
- Damn it.
Kerry! - Take the baby.
I need you here.
- Somebody call for OB? Yeah, that was fast.
Fill her in, Pratt.
Mom just delivered a 24-weeker now with severe atony, EBL 1500 cc's.
- What's happening? - You're doing good.
It looks worse than it is.
The tube in his mouth helps him breathe.
Catheters in his umbilical cord give him fluid, nutrition and medication.
But underneath it all he looks good for a 24-weeker.
Really.
Where's Zack? Zack? Zack? - What did she give him? - Four milligrams Haldol IM.
Just to tide him over till his p.
o.
meds kick in.
I'm sorry.
You never let me finish telling you about Quinamax.
Now, it's our new once-a-day antibiotic with excellent coverage for bronchitis and otitis media.
I could put together some packages for you to take to the Congo.
I've heard that's a pet project of yours.
Quinamax would be wonderful for the important work you're doing over there.
You want me to take your overpriced antibiotic to Africa? It has great coverage for pneumococcus and H.
flu.
Why hasn't there been a new drug for malaria in three decades? - That's a really good question.
- There's no profit in treating poor people.
- My company- - Your company spends twice as much in marketing as it does in development which is why prescription drug costs have tripled in the last 10 years.
- Get out.
I want you out of here.
- If this is a bad time- Frank, I'm gonna go get some coffee.
Page me if you need me.
Okay, Dr.
Kovac, if you could- You know, I'll just come back when you're not so busy.
Everything looks good.
Don't sound so surprised.
Ben, I really appreciate the gesture but I can't accept this.
Well, you said you liked it.
I do, but that book is worth a lot of money.
No, no, my first edition Brontës are worth a lot of money.
I just think it's inappropriate.
I didn't mean to hurt your feelings.
No, you didn't.
It's just that you've done a lot for me and, you know, I just want to show my appreciation.
I certainly never meant to make you feel uncomfortable.
No, no, you didn't make me feel uncom- It's no big deal.
I can help you get a ride if you wait.
No, I'll grab a cab.
Okay, same time next week for another level.
Thank you for the flowers.
I feel officially lousy.
So is it "Jing-My" or "Jing-May"? I'm getting conflicting information.
Call me Deb.
What are you doing after this, Deb? Wanna grab a beer, shoot pool? I can't.
I'm taking my parents to the airport.
I'll go with you.
We can go out after.
You'll drive my mother and father to the airport? - Good for embarrassing childhood stories.
- No, not my parents.
They're a little distant, bordering on xenophobic.
My dad has six toes.
Just on one foot.
Has anyone seen Alex? - He was hanging around here earlier.
- Could you find him for me, please? You should use your fireball.
This your first time playing? Nope.
You want me to show you how to do the dragon punch? Nope.
He's gonna kill you with his psychocrusher move.
Told you.
I'm thirsty.
That's a good sign.
- Can she have some ice chips? - Let's hold off for a little while.
You lost a lot of blood in your delivery.
We had to give you a transfusion but the bleeding's stopped now.
You're gonna be fine.
- We're taking your baby up to the NICU.
- Good.
- He's doing better.
- Just take him away.
- Denny, just- - Please.
- Has Abby shown up yet? -404.
Doing what? I've been paging you.
I was with this patient.
So I hear.
You convinced the family to donate his organs? Spending this much time with a patient is a luxury we don't usually have.
You missed out on an interesting volvulus repair.
Well, I just felt like his wife needed me.
You already do this well, Abby.
Sometimes being a doctor is about distancing yourself from your patient.
- You don't have to stay.
- I'd like to stick around if that's okay.
What the hell is this? - A Labrador retriever.
- Wrong answer.
- Some sort of spaniel.
A terrier.
- Who brought it into the hospital? Pratt? - I'm sorry, Dr.
Romano- - I did.
She belongs to me.
- This isn't a petting zoo.
- She's not a pet.
She's a Seeing Eye dog, aren't you? Oh, how could you hate a face this cute? - All right, come on.
Let's go home.
Bye.
- So where is my son? - Did you show him the morgue? - Couldn't find him.
I know where he is.
He's across the street in the new Jumbo Mart.
Got you now.
- That's cheating.
- I thought you were good at this game.
What the hell are you doing? - My shift ended an hour ago.
Why? - I'm not talking to you.
You cannot just wander off without telling me where you're going.
Did you eat all this? - Where did you get the money? - He bought it for me.
Do you know what time it is? Did you take your shot? No? Look at him.
He's hyperglycemic and ketotic.
Did you not notice anything strange? He's diabetic.
God, I can smell it from here.
I thought he was a street kid.
I didn't know he was your patient.
He's my son.
Hi.
Sorry to bother you.
Are you stalking me? Got his first x-ray.
His heart and lungs look good.
He's fighting.
Told you.
- Maybe you should get off your feet for- - I just wanna stay here a while.
Okay.
He shouldn't have to die alone.
Was this a bad idea? Oh, no, no, I love dogs.
I grew up with dogs.
My parents had a cattle farm outside of Gary.
So you were a farm boy? I still would be if my mother hadn't insisted on my going to college.
What about your parents? - Wanna hold her? - Oh, yeah.
My mom is a secretary.
Was a secretary.
- She wanted me to be a flight attendant.
- Really? Yeah, that wasn't happening.
She died a few years ago.
Oh, I'm sorry.
What about your father? He's still in Chicago.
He's a test pilot for Barcalounger.
He must be pretty proud of you.
You're not close? Not really.
- That's a shame.
- Yeah.
It happens.
- I have a daughter named Karen.
- Yeah? Yeah, I haven't I haven't talked to her in years.
You should try to reconnect.
No, it's not gonna happen.
You should call her.
No, she blames me for things when When my wife died.
I didn't see that coming either.
Your wife died suddenly? No, no, not really.
She had cancer.
She fought it for a long time but we both knew she wasn't gonna beat it.
Still, I guess I never expected it to end that way.
I just had trouble I had a hard time accepting - the finality of it all.
- Yeah.
- Three-forty.
- I didn't know he had diabetes.
He's a kid.
You're an adult.
You're supposed to be a doctor.
You didn't notice he was acting weird? Lots of kids his age are weird.
What are you doing playing video games with a 9-year-old? You give him ice cream, candy- What's up with that? Can I discharge Mrs.
Fionelli? - Find another Attending.
I'm off.
- Oh, all right.
Her pelvic sonogram results came back.
She's got an ovarian cyst so I was just going to put her on a non-steroidal.
She had an abdominal CT scan? We were thinking diverticulitis.
- Flip over your chart.
- What? On the back of your chart there's a price list of all tests and labs.
You ordered a CBC.
That's what? - One hundred and forty dollars.
- A chem panel and UA? - Three hundred and fifty, and 90.
- What else? GC and chlamydia cultures, 300.
IV start and a liter of saline, at least $200.
Morphine's another 50.
Abdomen and pelvic CT, 3000 easy.
- Did I miss anything? - Pelvic ultrasound, $750.
$4880.
You could have done a negative urine ICON to rule out ectopic for 15 bucks performed a thorough physical exam, treated her with a $2 dose of ibuprofen.
This is why we can't provide health care for everyone.
Hey, where's Logan? Rule-out subarachnoid? She was in Curtain 2.
- Dr.
Kovac discharged her.
- Oh, Neurology finally came down.
- Nope.
I did an LP about four hours ago.
- You did what? She'd been waiting all day.
Her fluid was clear.
No blood, no xanthochromia, no subarachnoid.
A spinal tap is the quickest, easiest way to rule out an SAH - and it's 100-percent sensitive.
- She was my patient.
Yes, and if I hadn't treated her she'd still be here.
- Now she's at home feeling better.
- So that's it? This is how I'm supposed to learn? I do it your way or you take it away? I'm trying to teach you the way you practice medicine here is inefficient.
Oh, and letting babies die is? You really think you saved that kid today? For what, 24-hour nursing care? He's gonna probably require a lifetime of commitment.
Are you gonna give it to him? I'm sorry I'm not in some mud hut doing amputations with a pocketknife.
We have the technology and expertise to give that kid a chance.
What's the sense of having it if we don't use it? That kid has about a 5-percent chance of having a normal life.
- You know how many others we could-? - I do everything I can for my patients.
That's how I practice medicine.
This is Chicago, not the damn Congo.
Maybe you should just go back to Africa.
Maybe you should go to Africa.
I know you didn't just say that to me.
Maybe you'd learn there's more to being a doctor than ordering tests and consults for every patient just to cover your ass.
Stay away from my patients.
From now on I'll present to another Attending.
You can just take big bites, you know.
The mortician will do what he can.
I need the practice.
All right, well, take your time.
He's not going anywhere.
What all will they take? His kidneys which would go to two people with end-stage renal disease and that would free them from a lifetime of dialysis.
His heart and lungs could go to as many as three people with cardiac and pulmonary disease.
His pancreas and intestines would go to children as well as adults.
His corneas would allow two people to see again.
His skin, bones and other tissue will help treat burn victims.
And his liver will be split into multiple transplants and used for children with birth defects that used to be fatal.
R.
Previously on E.
R.
Sam Taggart, new nurse.
I started my Surgical rotation today.
I'm back in med school.
- So no more nursing? - No.
I'm still gonna be taking a few shifts for a while.
I need the money.
What are you nutmeats doing? Clearing Triage.
We'll provide good care, and we're gonna do it faster.
We're gonna form a line down the hall, and you'll be examined three at a time.
- Is this your new hospital? - Yep.
It's even crappier than the last one.
I'm a 71-year-old man who's going blind.
I've considered everything.
I need you to promise me you're not gonna kill yourself in the next 72 hours.
But Monday would be okay? I'm off the hook by then.
E.
R.
10x06 "THE GREATER GOOD" "The friend had, in a weak hour, spoken with sobs of his own death.
He had delivered a melancholy oration previous to his funeral and had doubtless in the packet of letters presented various keepsakes to relatives.
But he had not died and thus he had delivered himself into the hands of the youth.
" Oh, sorry.
Are you taking your enalapril? - Yeah.
- Want me to bump up your Lasix? Coffee does the same thing.
It also raises your blood pressure.
Well, as luck would have it you gave me a pill for that too.
You want more espresso? Not unless I'm gonna fly to work.
"The latter felt immensely superior to his friend but he inclined toward condescension.
" You don't have to keep doing this.
Well, I've got time to finish the chapter.
I've never read this before.
It's good.
You don't have to keep coming here.
I don't have this book.
Keep it.
I'm I'm never gonna read it again.
That's why I'm here.
That and the coffee.
He died at 29.
Stephen Crane.
TB.
Just a little trivia.
Nice.
Very cheery.
"He adopted toward him an air of patronizing good humor.
His self-pride was now entirely restored.
" I like this place already.
Don't think they give away free doughnuts every day.
- Bars give away free peanuts.
- So you get thirsty and buy more beer.
If they gave away doughnuts, people would buy more coffee.
Please! Can you help me? I think I'm having a miscarriage.
- How many weeks? - Twenty-four.
- First pregnancy? - First one to last this long.
Oh, she's adorable.
I found six behind my apartment.
She's the last one.
- They don't allow pets in my building.
- They're not allowed in here either.
- Hey, buddy, want a doughnut? - Frank! What? Dogs love doughnuts.
Want a pooch? Free to a good home.
Dogs irritate my asthma.
Hi, I'm Terra King from Ladokern.
I have gifts and snacks for the Residents.
Is there some place I can set up? Lester.
Lester, can you take care of this, please? - What's wrong with him? - Come on.
Punch it, Cat Daddy.
- What are you guys watching? - Carjacking.
Pratt.
Needs to get on Lower Wacker to lose the chopper.
This is Denny.
Vaginal bleeding at 24 weeks.
Can you take her? - Sure, sure, let's go.
- Cheering for the carjacker to get away? No, we just want him to get a few more blocks.
South of Van Buren he's out of our catchment and goes to Mercy.
- If there's a crash - There's always a crash.
Turn left.
Get on the expressway.
- Yes, yes, go, go! - Go, go, go! - Damn it.
- That's gonna hurt.
You have friends downstairs but you can't let them take advantage.
- The patient was borderline.
- Precisely my point.
He needs to stay in the ER.
If his condition worsens, I'll go back down.
You know they're only too happy to free up beds by dumping patients onto Surgery.
Dr.
Corday, they need you in post-op and the ER is calling for a gallstone consult.
All right, you go down there, make your assessment and call me.
Be strong.
Colles' fracture.
Put on a sugar-tong splint and have him come back for casting after the swelling goes down.
- Vicodin for pain.
- Wrist film? It's not deformed.
Distal neuro-circ intact.
We'll get an x-ray when we cast.
Malik, get six units of O-neg down here before the car crash starts rolling in.
- Already ordered eight.
- Tell me about the gallbladder.
Fat and 40 with a history of gallstones.
I gave her a shot of Toradol.
She's afebrile.
Abdomen is non-tender.
- Good.
Send her home.
- No ultrasound? No.
No labs, no IV, no x-rays.
Tell her to stick to a low-fat diet.
- How'd you do this? - I was using a utility knife to open a box.
Be more careful.
Keep it clean and dry.
Come back in two days for a check.
- What's this? -24-year-old female, bladder infection - positive for leuks, ICON is negative.
- I ordered Bactrim and Pyridium.
Good.
Tell her to pee after she has sex.
It's a good way to prevent UTls.
Coop, your subconjunctival hemorrhage probably happened from sneezing and it will get better in a week.
Reassure your patient that he won't go blind and get him out of here.
Five patients in two minutes.
That's a record.
Make sure you're not skimping.
- Skimping? - Yeah, on the billing.
- Check off a few more boxes next time.
- I won't bill treatment we didn't provide.
It's called capitalism, Kovac.
Pays your salary.
Okay, there's the heartbeat.
Amniotic fluid index is good.
Excellent fetal movement.
- He's good? - Yeah, but you're dilated 3 centimeters.
I've already had two miscarriages.
I was supposed to start bed rest next week.
I can't go through this again.
I'll give you some medicine to stop you going into labor.
Junior needs a few more weeks before he's done.
Let's start with 0.
25 of terbutaline sub-Q and give 4 grams of mag.
Here, magnesium might make you a little queasy.
I'll be back in a few minutes to check on you, okay? Hey, Jerry, what's the ETA on our car crash? Two minutes and counting.
- Can I present a patient? - You better make it fast.
Woman, 23, sudden onset occipital headache, grade eight out of 10.
- Worst headache of her life? - Close.
- Thunderclap onset? - Two minutes.
No history of migraine.
Neuro exam is non-focal.
Okay, get a head CT, and rule out subarachnoid hemorrhage - and get 10 of MS for the pain.
- Thanks.
Kevin Dunn, 32-year-old driver, high-speed MVA with prolonged extraction.
- Jacker or victim? - Jacker.
Victim's behind us.
Lap belt.
Front impact.
BP, 104/84, pulse 106.
- Creamed the next guy real good.
- We were watching.
Should have turned left on Stanton.
I would have got away if that jerk didn't cut me off.
Oh, looks like a big flail segment and closed clavicle fracture.
- Put him in Trauma 2.
- Driver numero dos.
Thomas Collins, victim.
High-speed restrained impact with head injury.
Turn him, turn him, turn him.
Let's go.
Come on.
Come on.
I put Mrs.
Walters in Exam 2.
She needs a little TLC, maybe some Zoloft.
That makes two of us.
Look at them.
They are like kids in a candy store.
One hospital I worked at tried to ban drug reps but Residents complained.
They like the free food.
- How they hook you.
Food, equipment- - Oh, don't forget the boobs.
I imagine they have to pay for those.
Keep Kovac away from her.
He's been known to give away free physicals.
Okay, Ernie, where were we? I got worms.
- What the hell is this? - Looks like a hospital bill.
- Accounting, fifth floor.
- They wouldn't help me.
- Well, I can't either.
This is the ER.
- All right, Ernie, those are maggots.
- When's the last time you changed that? - Look, look, I was already there, okay? I sat here for 11 hours with my sick kid to have some quack tell me it was a virus and he'd get better on his own.
Did he? They didn't do anything for him and I get a bill for over 2 grand.
I wanna see the doctor who stiffed me.
- Carter.
I wanna see this Carter guy.
- He doesn't work here anymore.
- Come on! - Here's what we're gonna do.
I'll fix you up with a nurse, something to eat and a bath.
But your friends there, they gotta go.
- I want this fixed! - I wouldn't do that, sir.
Are you gonna do something about this bill? Are you gonna get off your ass? No.
But he is.
- Dr.
Kovac.
- Zack Isley, 6-foot fall into gravel no LOC, GCS 15.
Superficial lacs and abrasions on head and right upper extremity.
- Complaining of right shoulder pain.
- Hey, Zack.
Dr.
Kovac.
What happened? Just goofing around, took a header.
Can you straighten your arm? Okay, Curtain 2.
- I just sprained it.
- Why don't you let me decide that.
We'll get you an x-ray.
Clean those cuts and scrapes.
- Might even need some stitches.
- Really? Don't worry.
We'll numb you up.
You won't even feel it.
- No, no medicine.
I can take it.
- Tough guy, huh? Trauma panel, a clot, lateral C-spine, chest x-ray and AP pelvis.
Poor guy's driving down the street, minding his own business, then: - Wakes up in the ICU.
- If he wakes up.
- Can't see the pupils, too much blood.
- Laps and saline.
Chest is clear.
- BP is 140/94, pulse 72.
IV is blown.
- How are we doing in here? Well, he's gonna need to be tubed but we got it covered.
Thanks.
Abby, can you start an IV? Nurses start IVs.
Surgical students do cutdowns.
- Spank them, Abby.
- Somebody get me a central line kit? Yeah, I'll send one back.
On the monitor, BP's 106/80, tachy at 111.
- Triple lumen kit next door.
- I can't see into his airway.
- No blood in the nares or around mouth.
- SonoSite for Dr.
Cooper.
Pain meds on the fly but let's complete the survey.
Decreased on the left.
Sterile gloves, please.
BP's 104/86.
Sats 92.
All right, kids, you're on.
Show Dr.
Chen what you know.
Free fluid in the abdomen and pericolic gutter.
Try there.
You could use a little more jelly on your belly.
- You're the Attending.
- And in Morrison's pouch.
- Meaning? - Intra-abdominal injury secondary to high-speed mechanism.
Needs O.
R.
Start the chest tube.
I'll be right back.
Don't be a stranger.
- Guy next door needs a surgeon.
- I'll call Corday.
Mommy, come save me.
I'll decide if he needs surgery.
- He only responds to pain.
- Urine output's good.
Okay, laryngoscope.
No, no, Surgi-Girl, go next door.
Start the workup.
- Yeah, I was gonna intubate.
- Next time.
Now.
Go, go.
Get me a staple gun so I can put this guy together.
- I feel the inside of the chest wall.
- Surgery.
Hello, surgery.
Abby, can you turn that damn thing off? - Yeah.
- Okay, lead the guide finger in with the other hand, slide the tube through.
- Got it.
- Sats are up 98 percent.
- Thanks.
Nice job.
- Okay, Abby, give me the bullet.
I was trying to fix the monitor, sorry.
Oh, you're a med student, a nurse, and technician now.
What's next, cowgirl? I'm pushing the drugs.
You want this or not? - Yes.
- I told you to evaluate this guy.
- I can do it.
- I don't care who does it.
Neela, go with Dr.
Pratt.
Come back and sew these in when you're done.
Well? No fracture or dislocation.
You probably just strained the ligaments a bit.
- Told you.
- Maybe you should be a doctor.
Yeah, not with my grades.
I wasn't a great student at your age.
I almost failed lunch.
- Sorry.
- Kovac, this guy's here for your patient.
Ron Kennedy, I'm a social worker from Stadler House.
We're a foster care facility.
Zack's one of our residents.
- You mean prisoners.
- Relax.
I'm his caseworker.
Zack hopped a fence on an outing and ran off.
I escaped, you Nazi.
- Call my mom.
I'm not going back.
- Zack has a conduct disorder.
- Screw you! - Could you give us a moment? - I think he's off his meds.
- Back off, man.
- Hey, stop it, Zack.
- He needs Haldol.
- Go back to the waiting room.
- Get the hell out! - Get back in bed, Zack.
- He needs to be sedated.
Out! Hey.
I'm not going back there.
Please, don't let them take me back.
Please.
- Third crit is down to 29.
- Done.
Let's roll.
Call Corday, and tell her I'm sending her up a gift basket.
Looks good, but if it comes out, you owe us a beer.
I'm more a cosmo girl.
- Drink or magazine? - A little of both.
- Did Neurosurgery agree? - Yeah, diffuse axonal injury.
No operative lesion.
They'll sign off after the second test.
- He's brain-dead? - Yes.
Bad guy gets patched up, victim is a vegetable.
Haven't saved this guy yet.
Change that dressing.
- Which O.
R.
? - That's not your business.
Call UNOS.
Your butt's down here until the coordinator arrives.
You wouldn't feel it if you let me use just a little analgesic gel.
For six months I've been on Tegretol, lithium, Risperdal, clonidine Benadryl and Klonopin, okay? I've been so doped up I didn't know the day.
- Have you been cheeking your meds? - Had to.
- It's the first day I felt normal in months.
- That why you ran away? I got tired of being a freaking zombie.
- Did you call my parents? - Your mom's on her way.
You're not gonna let them take me back, are you? We'll talk about it when your mom gets here, okay? Hey, Pratt? - This scan's negative.
- Yeah.
I'm still waiting on a Neurology consult to evaluate a possible subarachnoid.
- Do an LP.
- They'll be here any minute.
You're wasting time and resources.
What's his problem? Besides being tackled in the waiting room? Possible new onset angina.
I've ordered nitro, CBC, chem panel, serial troponins and a chest x-ray.
And I'm still waiting on Cards.
- EKG's normal? - Yeah.
- You smoke? - No.
Hypertension? - High cholesterol, diabetes? - No.
I'm healthy.
I run about 12 miles a week.
Okay, let me guess.
The pain started after your incident in the waiting room.
Yeah.
It's an anxiety attack.
- Over this stupid hospital bill? - Probably.
Let me see it.
What's the complaint? My kid came in with a fever.
Your son didn't need that.
Certainly didn't need chem panel and two sets of blood cultures.
You should have only been charged for, what? Three hundred dollars.
Thanks.
Hey, Slavco.
What do you think this is, some Zagreb Yugo dealership? On the occasion we do get a patient with insurance, we don't give them deals.
I expect that kind of idiocy from Pratt, not from you.
I thought I was his favorite.
Hi.
I'm Terra King.
Have you heard of Quinamax? It's our new once-a-day antibiotic with excellent coverage for bronchitis and otitis media.
Neither of which needs treatment with antibiotics.
It has great gram-positive coverage, making it ideal for cellulitis.
I have a patient coming in at 3, Ben Hollander.
When he shows up, just let him in and come find me, okay? Sure thing.
Hey, what's up? I got a 27-year-old G3P-zero history of cervical incompetence, EGA, 24 weeks.
Presented in early labor cervical dilation progressed from three to six on terb and mag.
- Fetal distress? - No.
Looks good.
- Heart rate's in the 160s, good variability.
- Can you repeat the terb? No.
We're maxed out, and she's tachy.
Send her up to Labor Delivery.
Have a Pedes resuscitation team standing by.
If she's progressing on tocolytics, there's nothing we can do.
She's revealing both her upper and lower teeth when she laughs.
- What? - Chen.
It's a sign of flirting.
There.
Hair touching, another one.
Get in there before it's too late.
What are you talking about? I was a cop for 25 years.
You learn body language.
Look at that.
She's mirroring his motion.
Twenty bucks says she touches him next.
So what? She slapped him.
First it's a slap, then it's a tickle.
Before you know it, she'll be spanking his ass.
Jerry, can you call up to L and D? Tell them to make sure- - I need to find a fire hydrant.
- Hey, that's a cute puppy.
Can I hold it? You can have it.
Forty-three-year-old man with left flank pain radiating to the groin.
Denies fever, vomiting.
Exam's notable for CVA tenderness on the left.
- Urine heme-positive.
- Okay.
Diagnosis? - Kidney stones.
- What else? CBC, chem panel, and CT urogram.
- Okay.
And give 30 of ketorolac IV push.
- No.
No CBC, no chem panel, and no CT.
You don't even need the damn IV.
It's expensive and takes up nursing time.
Give him 60 of ketorolac IM and a bedside ultrasound to rule out hydronephrosis.
- You won't see where the stone is.
-90 percent of cases pass on their own.
- He's afebrile, and his UA is negative.
- And if it's too big to pass? It'll cause hydronephrosis, and he'll come back.
He still thinks he's in the Congo.
Get the CT.
You need to take him up.
That's not how it works.
I come down, I see, I present.
I know how it works.
I'm telling you as a surgeon and head of ER take this guy to your service.
Do I need to write you a damn note? "Dear Dr.
Corday, please admit Abby's patient.
He's very sick today and requires an ex-lap before he gets septic and dies.
" - You hanging in there? - By a thread.
- Dr.
Lewis, can you help me? - Sure.
Which patient? It's about the doctors.
I'm getting conflicting advice from Pratt and Kovac.
Welcome to County.
- Kovac is the Attending.
Pratt isn't.
- Abby.
This is Patricia Collins.
- Husband was involved in the car chase.
- Oh, I'm sorry.
Hi.
Abby Lockhart.
- I'm Neela.
- Hi.
I worked on your husband.
You'd like to see him? - Yes.
- I'll take Mrs.
Collins in while you're waiting for the UNOS team.
This way, please.
- I'm beginning to hate her.
- She's a med student.
I'm a med student.
Now that you mention it, she's pissing me off too.
Come on, let's hate her together.
Now, the medicine I gave you hasn't stopped you from going into labor.
Your contractions are increasing in frequency and your cervix is continuing to dilate.
My husband had to go to Seattle for work.
He didn't want to go, but I said, "Don't worry, I'll be fine.
" I can't believe I'm having another miscarriage.
No.
You're not miscarrying, Denny.
You're gonna have this baby.
I'm sending you up to Obstetrics.
They're set up to handle preemie delivery.
I don't want a preemie.
Our NICU cares for babies like this all the time.
Yeah, babies with brain damage.
My sister-in-law had a preemie.
They spent every day in the NICU and it still died.
- This baby has a chance.
- I don't want it this way! Okay.
Okay.
Problem? She doesn't wanna have the baby.
- She's 24 weeks.
- What's the weight? Five hundred twenty grams on the ultrasound.
Twenty-four weeks, over 500 grams? That's the hospital's viability threshold.
We're gonna spend half a million keeping one baby alive while we shut down the lead eradication program? I've admitted three kids for chelation this week.
Why stamp out lead poisoning? Just shoot your wad on a little gorker who can enjoy a lifetime of special ed.
What am I supposed to do? Mom doesn't want to save this baby.
She doesn't have any rights.
If it's over - Aren't you on a surgical rotation? - Yup.
- Then rotate.
- What's the kid's chance of a normal life? - Ten percent? Less? - It's hospital policy, Luka.
- Change the hospital.
- Another good idea.
Let's send her to Santa Niña Muerta Hospital.
It's called natural selection.
Heard of it? It's worked for a few million years.
So tell me, what should I do now? Hospital policy exists for a reason.
First learn the rules, then learn when to break them.
What's in her best interest? The laceration is superficial, and his shoulder is only bruised but I do have some concerns about the medication he's on.
- Zack's had some problems.
- Had.
I'm fine now.
I think he may be overmedicated.
They told me that was for his own good.
I had a drug problem.
I let him run wild.
And then he was always doing this crazy stuff.
- He got into fights.
- It's called self-defense.
- He stole a car.
- One time.
I'm not doing that anymore.
They blamed it on me.
They said I was an unfit mother.
Do you have custody? Not at the moment.
- Has Ben Hollander shown up yet? - Not that I've seen.
Can you look at a possible scaphoid fracture in Exam 3? Yeah.
Hold on a second.
Mrs.
Collins refused to donate her husband's organs.
I've heard minority families seldom agree to organ donation.
What, did you just let her leave? I told her she could sit with the body until he went up to the ICU.
I'm looking for Dr.
Pratt.
Greg.
There he is.
It's 2003.
He doesn't have an answering machine.
He promised me.
We have a therapeutic contract.
Look, I'm sure he's just running late.
Maybe he stopped to get a coffee or Jump off a bridge? - Hi.
From Neonatology? - Yeah.
Vargas.
Where's your patient? Her name is Den- - Hey, Lily, where's Denny? - I haven't seen her.
- Can you check the bathrooms? - Sure.
Just give me one second, all right? I'll find her.
- She left.
- Who? My pregnant patient.
You talk to her? - No.
- Well, she took your advice.
She eloped.
That was always her prerogative.
- I need a doctor out here.
- Doesn't mean it was the best thing for her.
- You're supposed to be teaching me.
- I'm trying, you're not listening.
Some lady is in the back of my cab.
I think she's bleeding to death.
Denny, what happened? I tried to make it to Saint Joe's but the baby's coming.
- Is she dying? - No.
Run inside.
Tell them I need a gurney and a BOA kit.
- Go! - This is in her best interest? She wouldn't have left if you'd done what she asked.
Type and cross Mom for four units, two large-bore IVs and a liter of LR running now.
It's too soon.
All right, Denny.
One big push.
Let the NICU know we've got a 24-weeker on the way.
- Come on.
Cord clamp.
- Please, don't save him.
- It's a boy.
- Eyelids are still fused.
Let him go.
I asked for two lines.
Who's working on the second IV? - Come on, we need access.
Let's go.
- Full respiratory effort.
- Placenta's delivered.
- I don't want this baby.
Bleeding's picking up.
- Heart rate's in the 130s.
- Yeah, uterine atony from the tocolytics.
Run in another liter of LR and 20 of Pit.
- Do you have a pulse? - Slow, under 100.
- Start compressions? - Bag him up first.
No, you need to weigh him before anything else.
Less than 500 grams, we stop.
Draw up some epi, get ready with the tube.
Do not tube that baby until you get a weight.
You hear me, Pratt? I mean it.
- No tubes, please.
- Five hundred and six.
- No.
- Pratt, she doesn't want this.
- I'm following hospital rules.
- Doesn't make it right.
- This kid is alive.
- Systolic's down to 78.
and rush the blood bank.
All right, I'm in.
Bag him and give You got it.
Mrs.
Collins, can I get you anything? Or anyone I can call? Tom's sister is coming.
She wanted to say goodbye.
Sorry.
Shouldn't be doing this, Pratt.
She has the right to demand a natural death.
We have a family room.
If you'd like to wait for your sister-in-law in there, it's a little more quiet.
- I wanna stay with him as long as I can.
- Okay.
What's happening? They're trying to save a premature baby.
We just started trying to have kids.
Mrs.
Collins, did Neela talk to you about recovering your husband's organs? I told her I didn't want that.
He's been through enough.
Why? Does he have something that could help the mom or her baby? I don't know.
Maybe.
But there are lots of others who would benefit.
Tom was always going out of his way to do stuff for other people.
To the point where they would take advantage of him, but he didn't care.
I would always tell him, "Don't you know nice guys finish last? " He would always say: "Guys who finish last are nice.
" He was so stupid.
What would they do if he was a donor? The recovery team would take him to the ICU.
And they run tests, and they start matching his organs - to people who need them.
- Like his kidneys? Several organs can be recovered.
He could help as many as 50 different people.
Tom would like that.
What all will they take? Well, his kidneys which would go to two people with end-stage renal disease and that would free them from a lifetime of dialysis.
Ben Hollander, Susan Lewis.
No, I'm the doctor.
He's my patient.
County General.
Okay, then I'll talk to the watch commander.
My mom around? - In a trauma.
Wait in the doctor's lounge? - No.
You get any freaks in here today? Guys with Elephant-Man disease and axes stuck in their head? - No.
- Should you be looking at that? I'm gonna become a doctor.
Dollars to doughnuts that kid is already dissecting the neighborhood pets.
When you put me on hold, you increase the chance he's in trouble.
- Sure.
- Hey.
You wanna see a puppy? Why? I don't know.
Because she's cute? Where's the morgue? Your mom says we aren't allowed to let you go there.
I'll give you 5 bucks.
- That kid ever give you the creeps? - He's right at the age where it starts.
Teen rebellion? Devil worship.
Keep an eye on that puppy.
Never mind.
- You were supposed to be in hours ago.
- Oh, I'm sorry.
Oh, these are- These are for you.
Sort of a peace offering to make up, you know, for my tardiness.
You didn't have to do that.
Well, there's a guy outside, you know, selling them on the street so it's, you know, no big deal.
Oh, and I I brought you this.
We're not finished reading it.
Well, you know, I know how it ends.
Lily, can you set Ben up for a blood draw? Sure.
This way, sir.
- That patient brought you flowers? - And a book.
He's a Civil War buff.
I've been reading to him.
He's losing his sight.
You're going to his house? Yeah.
The guy was a possible OD on Dig a couple weeks ago.
I'm still not sure it wasn't attempted suicide.
Wanna make sure he's reengaged before I cut him loose.
This is a first edition.
Sounds like he's engaged with you.
He has no one.
He's going blind.
He sacrificed everything for his career and now he has nothing.
No one should end up like that.
- Where the hell is OB? - Paged them three times.
Denny, stay with us here.
- EBL 1500 cc's.
- I'm hitting resistance.
When it bounces back, you're in the liver.
Thread it again.
- Get him upstairs, Pratt.
- Kovac, I need to talk to you.
- Kind of busy.
- What's the holdup with that kid from Stadler House? They're threatening legal action.
- Still waiting on a Tegretol level to- - No, you're not.
It's back.
He can't go back there, Kerry.
Their treatment program is keeping him so drugged that he can't think straight.
- BP's up to 98/55.
- Good.
He's a nice kid.
You know better than the psychiatrist who's been treating him for two years? - She has too many patients.
- She also has privileges in this hospital.
She's on her way to administer Haldol because the ER physician refused.
Everybody's so concerned about the rules and policy they forget there's a kid caught in the middle.
Reform the foster-care system on your own time.
Neela, come with me.
- Discharge this patient.
- Damn it.
Kerry! - Take the baby.
I need you here.
- Somebody call for OB? Yeah, that was fast.
Fill her in, Pratt.
Mom just delivered a 24-weeker now with severe atony, EBL 1500 cc's.
- What's happening? - You're doing good.
It looks worse than it is.
The tube in his mouth helps him breathe.
Catheters in his umbilical cord give him fluid, nutrition and medication.
But underneath it all he looks good for a 24-weeker.
Really.
Where's Zack? Zack? Zack? - What did she give him? - Four milligrams Haldol IM.
Just to tide him over till his p.
o.
meds kick in.
I'm sorry.
You never let me finish telling you about Quinamax.
Now, it's our new once-a-day antibiotic with excellent coverage for bronchitis and otitis media.
I could put together some packages for you to take to the Congo.
I've heard that's a pet project of yours.
Quinamax would be wonderful for the important work you're doing over there.
You want me to take your overpriced antibiotic to Africa? It has great coverage for pneumococcus and H.
flu.
Why hasn't there been a new drug for malaria in three decades? - That's a really good question.
- There's no profit in treating poor people.
- My company- - Your company spends twice as much in marketing as it does in development which is why prescription drug costs have tripled in the last 10 years.
- Get out.
I want you out of here.
- If this is a bad time- Frank, I'm gonna go get some coffee.
Page me if you need me.
Okay, Dr.
Kovac, if you could- You know, I'll just come back when you're not so busy.
Everything looks good.
Don't sound so surprised.
Ben, I really appreciate the gesture but I can't accept this.
Well, you said you liked it.
I do, but that book is worth a lot of money.
No, no, my first edition Brontës are worth a lot of money.
I just think it's inappropriate.
I didn't mean to hurt your feelings.
No, you didn't.
It's just that you've done a lot for me and, you know, I just want to show my appreciation.
I certainly never meant to make you feel uncomfortable.
No, no, you didn't make me feel uncom- It's no big deal.
I can help you get a ride if you wait.
No, I'll grab a cab.
Okay, same time next week for another level.
Thank you for the flowers.
I feel officially lousy.
So is it "Jing-My" or "Jing-May"? I'm getting conflicting information.
Call me Deb.
What are you doing after this, Deb? Wanna grab a beer, shoot pool? I can't.
I'm taking my parents to the airport.
I'll go with you.
We can go out after.
You'll drive my mother and father to the airport? - Good for embarrassing childhood stories.
- No, not my parents.
They're a little distant, bordering on xenophobic.
My dad has six toes.
Just on one foot.
Has anyone seen Alex? - He was hanging around here earlier.
- Could you find him for me, please? You should use your fireball.
This your first time playing? Nope.
You want me to show you how to do the dragon punch? Nope.
He's gonna kill you with his psychocrusher move.
Told you.
I'm thirsty.
That's a good sign.
- Can she have some ice chips? - Let's hold off for a little while.
You lost a lot of blood in your delivery.
We had to give you a transfusion but the bleeding's stopped now.
You're gonna be fine.
- We're taking your baby up to the NICU.
- Good.
- He's doing better.
- Just take him away.
- Denny, just- - Please.
- Has Abby shown up yet? -404.
Doing what? I've been paging you.
I was with this patient.
So I hear.
You convinced the family to donate his organs? Spending this much time with a patient is a luxury we don't usually have.
You missed out on an interesting volvulus repair.
Well, I just felt like his wife needed me.
You already do this well, Abby.
Sometimes being a doctor is about distancing yourself from your patient.
- You don't have to stay.
- I'd like to stick around if that's okay.
What the hell is this? - A Labrador retriever.
- Wrong answer.
- Some sort of spaniel.
A terrier.
- Who brought it into the hospital? Pratt? - I'm sorry, Dr.
Romano- - I did.
She belongs to me.
- This isn't a petting zoo.
- She's not a pet.
She's a Seeing Eye dog, aren't you? Oh, how could you hate a face this cute? - All right, come on.
Let's go home.
Bye.
- So where is my son? - Did you show him the morgue? - Couldn't find him.
I know where he is.
He's across the street in the new Jumbo Mart.
Got you now.
- That's cheating.
- I thought you were good at this game.
What the hell are you doing? - My shift ended an hour ago.
Why? - I'm not talking to you.
You cannot just wander off without telling me where you're going.
Did you eat all this? - Where did you get the money? - He bought it for me.
Do you know what time it is? Did you take your shot? No? Look at him.
He's hyperglycemic and ketotic.
Did you not notice anything strange? He's diabetic.
God, I can smell it from here.
I thought he was a street kid.
I didn't know he was your patient.
He's my son.
Hi.
Sorry to bother you.
Are you stalking me? Got his first x-ray.
His heart and lungs look good.
He's fighting.
Told you.
- Maybe you should get off your feet for- - I just wanna stay here a while.
Okay.
He shouldn't have to die alone.
Was this a bad idea? Oh, no, no, I love dogs.
I grew up with dogs.
My parents had a cattle farm outside of Gary.
So you were a farm boy? I still would be if my mother hadn't insisted on my going to college.
What about your parents? - Wanna hold her? - Oh, yeah.
My mom is a secretary.
Was a secretary.
- She wanted me to be a flight attendant.
- Really? Yeah, that wasn't happening.
She died a few years ago.
Oh, I'm sorry.
What about your father? He's still in Chicago.
He's a test pilot for Barcalounger.
He must be pretty proud of you.
You're not close? Not really.
- That's a shame.
- Yeah.
It happens.
- I have a daughter named Karen.
- Yeah? Yeah, I haven't I haven't talked to her in years.
You should try to reconnect.
No, it's not gonna happen.
You should call her.
No, she blames me for things when When my wife died.
I didn't see that coming either.
Your wife died suddenly? No, no, not really.
She had cancer.
She fought it for a long time but we both knew she wasn't gonna beat it.
Still, I guess I never expected it to end that way.
I just had trouble I had a hard time accepting - the finality of it all.
- Yeah.
- Three-forty.
- I didn't know he had diabetes.
He's a kid.
You're an adult.
You're supposed to be a doctor.
You didn't notice he was acting weird? Lots of kids his age are weird.
What are you doing playing video games with a 9-year-old? You give him ice cream, candy- What's up with that? Can I discharge Mrs.
Fionelli? - Find another Attending.
I'm off.
- Oh, all right.
Her pelvic sonogram results came back.
She's got an ovarian cyst so I was just going to put her on a non-steroidal.
She had an abdominal CT scan? We were thinking diverticulitis.
- Flip over your chart.
- What? On the back of your chart there's a price list of all tests and labs.
You ordered a CBC.
That's what? - One hundred and forty dollars.
- A chem panel and UA? - Three hundred and fifty, and 90.
- What else? GC and chlamydia cultures, 300.
IV start and a liter of saline, at least $200.
Morphine's another 50.
Abdomen and pelvic CT, 3000 easy.
- Did I miss anything? - Pelvic ultrasound, $750.
$4880.
You could have done a negative urine ICON to rule out ectopic for 15 bucks performed a thorough physical exam, treated her with a $2 dose of ibuprofen.
This is why we can't provide health care for everyone.
Hey, where's Logan? Rule-out subarachnoid? She was in Curtain 2.
- Dr.
Kovac discharged her.
- Oh, Neurology finally came down.
- Nope.
I did an LP about four hours ago.
- You did what? She'd been waiting all day.
Her fluid was clear.
No blood, no xanthochromia, no subarachnoid.
A spinal tap is the quickest, easiest way to rule out an SAH - and it's 100-percent sensitive.
- She was my patient.
Yes, and if I hadn't treated her she'd still be here.
- Now she's at home feeling better.
- So that's it? This is how I'm supposed to learn? I do it your way or you take it away? I'm trying to teach you the way you practice medicine here is inefficient.
Oh, and letting babies die is? You really think you saved that kid today? For what, 24-hour nursing care? He's gonna probably require a lifetime of commitment.
Are you gonna give it to him? I'm sorry I'm not in some mud hut doing amputations with a pocketknife.
We have the technology and expertise to give that kid a chance.
What's the sense of having it if we don't use it? That kid has about a 5-percent chance of having a normal life.
- You know how many others we could-? - I do everything I can for my patients.
That's how I practice medicine.
This is Chicago, not the damn Congo.
Maybe you should just go back to Africa.
Maybe you should go to Africa.
I know you didn't just say that to me.
Maybe you'd learn there's more to being a doctor than ordering tests and consults for every patient just to cover your ass.
Stay away from my patients.
From now on I'll present to another Attending.
You can just take big bites, you know.
The mortician will do what he can.
I need the practice.
All right, well, take your time.
He's not going anywhere.
What all will they take? His kidneys which would go to two people with end-stage renal disease and that would free them from a lifetime of dialysis.
His heart and lungs could go to as many as three people with cardiac and pulmonary disease.
His pancreas and intestines would go to children as well as adults.
His corneas would allow two people to see again.
His skin, bones and other tissue will help treat burn victims.
And his liver will be split into multiple transplants and used for children with birth defects that used to be fatal.