ER s10e08 Episode Script
Freefall
E.
R.
Previously on E.
R.
- What are you doing? - Cut it out! - What are you doing? - He just grabbed my ass.
What are the odds we're gonna find someone better? We should spend either all our time together or none at all and I'm kind of leaning towards none at all.
- Sign it.
- This goes up to Human Resources? Stays with me, until I have a fat enough file to pull the trigger.
Bang! E.
R.
10x08 "FREEFALL" Sinus tach, 130.
BP's up, 220/140.
- Come on.
He's gonna blow an O-ring.
- Let's try Nipride.
- Oh, how did the paramedics miss this? - Cocaine? - Could be.
- Hold the Nipride.
He needs a beta-blocker.
Five of metropolol, IV push.
Heart rate's up to 140.
- Metropolol's in.
- He's seizing.
Okay, two of Ativan.
What are the physiological effects of cocaine? - A sympathetic stimulant.
- Alpha or beta? - Both.
- V-tach.
- Starting compressions.
- Charge to 200.
Check for pulse with compressions.
Clear.
V- fib.
Charge to 300.
- Amp of epi.
- Beta-blocker made him worse.
Clear.
No change.
-360.
Maybe he's allergic.
- I doubt it.
By blocking beta, you left alpha unopposed.
BP's high and his brain's bleeding.
Clear.
Asystole.
- Amp of atropine.
- What should she give? - Phentolamine, esmolol.
- Gold dot for your forehead.
- I've seen beta-blockers work.
- You have nursing experience meaning you can handle - Also means you might kill the others.
- He's not dead yet.
- Another amp of epi.
- Forget it.
That's it.
Stop compressions.
Just another dead junkie.
Congratulations, Abby.
You managed to kill the practice dummy.
Okay, reset for the next student.
Shame we have to work the holiday.
- You got family in town? - No.
Your overdose was harder than my dialysis patient with hyperkalemia.
- I need the room to hold an ICU admit.
- Sorry, bad MVA coming in.
- Where do I put him? - Anywhere, long as it's in the hallway.
- Come on.
- Can't you just get me some pills? That wouldn't be safe.
Mr.
Garland has pneumonia with hypoxia.
You need IV antibiotics.
I need to be with my family for Thanksgiving.
They can come and visit you here.
- How was the mock code? - Fine.
- So Romano humiliated you? - I looked like an idiot.
He does that to everyone.
Or maybe I just don't get it.
You'll catch on.
It just takes a little time.
Stay up there, turkey.
Come on.
- Son of a bitch.
- Better call the coroner on that one.
The damn night shift was supposed to do this.
- I'm just in charge of the potluck.
- Well, my yams are in the lounge.
- How many admits are we holding? - You don't wanna know.
No, there's a sandwich in the fridge.
And don't answer the door until I get home.
All right.
See you soon.
- Everything okay? - I had to leave Alex home for the day.
- He'll be all right.
- It's just until 3.
I finally get to make my kid a real Thanksgiving dinner.
Most years I work.
That's Lily's.
- Thought it was the potluck.
- There's a coffee club.
Yeah, you have to pay every month.
- Sorry.
How much? - It's a nurse's coffee club.
Okay, time to stamp out disease.
- Hand lac for Coop.
- Hit me again.
Oh, one per customer.
Asthma for Neela.
- Vag bleeding for Abby.
- Lovely.
And "bugs are crawling under my skin" for Lester.
- Cool.
- Pratt, will you take incoming trauma? Yeah.
Hey, Frank.
What's up with the stupid parade? Put the game on.
Kickoff isn't till 12:30.
My brother-in-law is marching with the Brundy County Sheriff's Posse.
Oh, yeah, what's that? Some sort of clan? - Morris, what do you think you're doing? - Picking up a patient.
You just skipped over bloody diarrhea for eye pain.
- Smile! - Frank.
Sorry, I didn't think this old thing would work.
It was in last year's box.
Couple of shots left.
What do you figure is on there? Romano and Weaver in a compromising position.
I'll get double prints then, just in case.
October 14th.
Six weeks and three days.
- So I'm still pregnant? - We'll check an ultrasound.
How heavy is the spotting? Couple of pads so far.
Are you taking any medications? Prenatal vitamins, AZT, 3TC, indinavir.
- You're HIV-positive? - Yeah, for 10 years.
Never shared a needle, no blood transfusions.
Just a loser boyfriend with too many chicks on the side.
- Anyone here with you today? - My fiancé.
He's driving up from Iowa City.
This guy's the real deal.
- Abby? - Excuse me.
- Three sick calls for night shift.
- Right, sick.
On Thanksgiving.
Call the registry.
We really need someone who knows the floor.
No.
No way.
I'm on all day as a med student.
I only work nursing shifts on weekends.
I can let you off your rotation at 5 so you can take a nap.
- Can you take one for the team? - No.
Fine.
Only if you can't find anybody else.
- Okay.
- Thanks.
So you're not using the eye drops? My nephew gave me an herbal medicine.
What, some sort of homeopathic crap? - Morris, come on, man.
Trauma's here.
- I think it's called Kona Gold.
- Morris, grab some me some 4-by-4's.
- Yeah.
Okay, this is pretty deep.
I wanted to use the carving knife.
She made me use the other thing.
- It's from Germany.
- Morris! Morgan Westbrook, collision with intrusion.
BP 80 palp, pelvic fracture.
O2 sats, 98.
No significant head trauma.
Didn't get altered until he dropped pressure.
On the phone to his doctor when we pulled up.
Drives a Bentley.
Nice.
Okay, prime the rapid infuser.
Come on.
Let's go.
Here we go.
On my count.
How do we tell pelvic bleeding from intra-abdominal? - CT scan.
- If the patient's unstable? Ultrasound? No, suprapubic mini-lap and DPL.
Which you can assist on.
Pupils equal and reactive.
- We got some sewing for you too.
- Can you two handle this? - Oh, I should hope so.
- I need to get back to my glaucoma patient.
- This is a primo case.
- I'm worried about angle closure.
- No hemotympanum.
- I need to check eye pressures.
Equal breath sounds.
- Is he squeamish? - No, just stupid.
- Frank, where are the nurses? - With patients.
I need a chaperone.
Sam, help me with a pelvic? - After I hang blood.
- Can we bring a few patients back? Eventually.
I've done solo pelvics.
I could help, if you'd like.
- That's okay.
Thanks.
- No, we are boarding five ICU players and it's total gridlock.
I'll give you an hour.
Mr.
Garland, looks like you might be with us for a while.
Not a problem.
- What's that? - Turducken.
What? It's a chicken stuffed in a duck stuffed in a turkey.
- Want a taste? - Maybe later.
Sorry.
No, no, it wasn't you.
Just a cramp.
There's a little bit more bleeding than I expected.
And the cervix is open.
Meaning? With the cervix open, you can't maintain a pregnancy.
I'm sorry.
I had a feeling.
I woke up, and something Something was strange.
We've been trying to get pregnant For how long? Loren? Loren? Damn it.
- Can I help you? - This is Abby.
Who's at Admit? - Just me and the food.
- Well, my patient's bleeding out.
I'll see who I can rustle up.
Could use a little help here! - Systolic's 110 after two units.
- Spontaneous eye movements.
- Mr.
Westbrook? - Where am I? You' re at County General.
You got clipped by a tow truck.
Try not to move your leg.
- What do you think you're doing? - Calling my lawyer.
- I'd rather not be treated here.
- May have internal bleeding.
- I'll take my chances.
- Your phone interferes with our equipment.
- Hello.
It's Morgan Westbrook- - Hey, I said no cell phones! Hello, Mr.
Westbrook.
I'm Robert Romano, chief of Emergency Services.
I just got off the phone with our CEO, Peter Fenwick.
- Oh, Peter was in my class at Wharton.
- Yeah, so I heard.
I think your employees need a lesson in customer service.
This one stole my phone.
Well, he's not long for this hospital.
We're taking him up to CT.
Great.
After a few tests, we'll transfer.
- Thank you.
- You're welcome.
You are in excellent hands with Dr.
Corday.
Believe me, I envy you.
Hey.
Come here.
That guy is the biggest real estate developer in Chicago.
- More like the biggest prick.
- When you get a VIP, sometimes- You treat everybody the same.
- He's not stable.
- If he has no organ injuries, I say he is.
You're making a mistake.
Could have ongoing hemorrhage.
My only mistake was to allow you to practice medicine.
You'll compromise patient care to suck up to some rich guy? We will determine if he's able to be transferred- I'm not signing any transfer papers.
You don't have to.
You're no longer on the case.
Great.
My name won't be on your malpractice suit when he dies.
As far as I'm concerned, you don't work here.
- Right.
- No, I'm serious, Pratt.
You just pissed me off for the last time.
Second liter's in.
Pressure's 100/60.
Hey, Loren.
Gave us a little scare.
You passed out from blood loss.
That doesn't sound good.
There can be retained tissue that keeps bleeding.
- Hemoglobin's 9.
4.
- Okay, type and cross for two.
- How do you stop that? - With a D and C.
We clean things out, and then you're back to normal.
Abby.
- Let's get you a fresh gown.
- I'll be right back.
There is no retained tissue.
She has multiple uterine fibroids.
It won't be as simple as a D and C.
You should be careful what you say.
- Most of the time, it's retained- - Not in her case.
Transfuse two units and call GYN.
We have to get this bleeding to stop.
Next time, wear oven mitts when you take out the turkey, okay? Oh, there.
Hey, Frank, what's the score? First quarter, 0-0.
Oh, you're back from the scan? Bilateral pubic rami fractures and a shattered acetabulum.
- Ouch.
- We got Todd Corbett on standby at the Mayo Clinic.
Hey, you think I'll be able to run the marathon next October? I'd say there's a good chance.
That guy could put Humpty Dumpty back together again.
Be right there.
What part of "you're off the case" don't you understand? Looking out for the patient's best interests.
Did you send off another CBC? - Keep it up, Pratt.
- What, another letter in my file? We're meeting with Weaver and Anspaugh.
- On Thanksgiving? - That's right.
Well, I guess it saves you from spending it alone.
- Did you call Psych about your bug guy? - No, he really has scabies.
My asthma girl's worse.
Call RT for heliox.
Lewis, get coverage for Pratt's shifts starting tomorrow.
Complex laceration? I repaired the extensor tendon with a figure of eight.
- Looks nice.
- Very tidy.
Abby, where's the abductor pollicis brevis insert? - You know its innervation? - Smile! My patient needs blood.
Put your dirty clothes in the hamper.
Check your sugar? Timoptic, one drop two times a day.
What about the other stuff? You don't need it.
It's illegal.
Just say no.
- Just say no to what? - Altar boys.
Look at this rack.
- Do I have to? - We gotta treat patients in Triage again.
- Meet them and street them.
- Not so fast, Luka.
Couple of problems in the hall.
Jeffries spiked to 104.
Tylenol, blood cultures and a gram of cefotetan.
When can he go up? - Fifth in line for Med-Surg.
- Mrs.
Paulson's now altered.
- Two tele admits in front of her.
- How are you doing, ma'am? Thirty cc's of lactulose and draw an ammonia level.
And Mr.
Garland's BP is down to 90 systolic.
Start dopamine at five mics.
- Sorry for the delay, sir.
- That's okay.
I like to people-watch.
- Can you help us at Triage? - No.
- Why not? - You gave me an hour's worth of orders.
This is ridiculous.
No beds, no staff and we're doing the work of the entire hospital.
Yep, welcome to my world.
I need hard restraints for Mr.
Garland.
- Garland? He's a pussycat.
- The kind that lock.
Have you ever had any problems with general anesthesia? Hepatitis? No, they check my liver enzymes on the triple cocktail.
I need you to sign a consent form for exploratory surgery and a possible hysterectomy.
- Hysterectomy? - Only as a last resort.
Nobody said anything about a hysterectomy.
It may be our only option if we can't control the bleeding.
No.
I wanna have kids.
- I appreciate that.
- Dr.
Coburn, do you have a minute? Hang two more units and check another hemoglobin.
Why do a hysterectomy for fibroids? - It might save her life.
- There are other options.
I don't justify my approach to a nurse.
- I'm a fourth-year med student.
- We consent for all contingencies.
Are you even going to attempt embolization? That would take hours.
Okay, I'm not sure I'm getting your point.
She's bleeding out.
She's on her fourth unit, not stable for embolization.
And maybe she would be if she wasn't HIV-positive? - What are you accusing me of? - Let me settle this catfight.
Abby, you're wrong.
I'm discussing uterus-sparing procedures.
- On an HIV-positive woman? - Thank you, I can handle this.
- She wants to have a baby.
- Maybe this is God saying, "Bad idea.
" With a low viral load, transmission's less than 3 percent.
And the kid'll be motherless by age 10.
I'll attempt a myomectomy, but I can't make any promises.
- Rotator-cuff tear.
- I thought it was a game of touch football.
My sister-in-law doesn't like to lose.
- Happy Thanksgiving, Dr.
Lewis.
- Excuse me.
Thank you.
Don't thank me.
Thank some dead guy from Mercy.
- Very romantic.
- So you in the mood for some late-night pumpkin pie? - You know what? I'm beat.
- I'll bring the whipped cream.
- Maybe another time.
- You okay? - Yeah, I'm just tired.
- Of me? GSW to the face en route.
Morris, you're with me.
Talk to you later.
Two liters NC, TKO the saline.
Five-minute ETA on the private chopper.
I'm Chuck.
Dr.
Hewitt from Northwestern.
I'll be flying with you.
Hands inside the car, man.
I appreciate everything you've done, Dr.
Romano.
- My pleasure.
- You coming up to the copter? I'd like to, but as you can see, we are completely swamped.
- I don't know how you do it, Robert.
- I guess it's just my calling.
Thanks a lot.
Take care.
Have a good flight.
Thank you.
Hold that elevator.
So you still think there's a chance? - Yeah, I do.
A good one.
- Abby.
Mrs.
Marshall is praying to the porcelain god again.
Okay.
- Reglan and Tagamet.
- My fiancé's coming to the ER.
Okay, I'll bring him up, and I'm gonna scrub in, make sure you're okay.
This is for painkillers.
Keep them.
After 10 years of marriage, I'm immune to pain.
- Helium gets deeper into the lungs.
- I won't float away? No, but you may talk funny.
- Frank, Pedes ICU have a bed yet? - In your dreams.
- Hey, chow line's open.
- I think you forgot something.
- What? - Emesis basins.
- Shouldn't you be on the roof? - No.
Mr.
Moneybags left his Rolex in the Trauma Room.
- Have one of the nurses take it up.
- They're busy.
Hey, Indira, take that up to the helipad.
- How do I get there? - I don't blame you for being scared.
The last thing you need is to lose another limb up there.
Come on, I'll take you up.
- Someone stole my medicine.
- Talk to the hand.
- What kind of medicine? - For my glaucoma.
- Who was your doctor? - Young guy, red hair and goatee.
GSW to the mid-face.
Where the hell is Morris? So about tonight.
It's okay that I'm coming for dinner? What? Alex invited me.
- What is this? - Septic pneumonia patient.
- We don't have any beds.
- Neither do we.
- You said they accepted him.
- You have to call report.
Here is your report: 72-year-old pneumonia patient on cefotaxime five mics of dopamine and six liters of O2.
- He might leave AMA.
- What are you doing? Take it easy.
He's a troublemaker.
- This is really stupid.
- You have more nurses.
We can't take extra patients.
Why not? We do it all the time.
Now you can't send him back.
Are you coming? Dr.
Romano? Here, take it.
- Patient forgot his watch.
- Thank you.
- Keep your head down.
- I know the drill.
This isn't your flight.
Dispatch sent me.
- Only room for two attendants.
- Me and the doc.
No, I have to go.
Insurance requirement.
She's off the flight.
Hey! - What the hell do you think you're doing? - Nothing.
- Give me that.
- It's not what you think.
Get your ass inside, sit down at Admit and do not move until I come get you.
The strap is caught.
- Fine.
Just call the nursing supervisor.
- You're not helping to solve the problem.
No! Open up four ORs and get every surgeon down here.
- Three criticals out here.
- Copy that.
Mike? - Yo.
- O2 and IVs outside.
Let's go.
Lester, we need backboards, man.
- Dr.
Pratt? - From the roof.
- Morris, get busy.
- I can't.
- Decreased breath sounds.
- Weak carotid pulse.
What's open? - Trauma 2.
- Chest tube, ET and two large-bore IVs.
- Send X-ray for a portable.
- Set up a Thora-Seal? No, no.
I need you to triage.
Go.
We got this.
Go.
- Neela, grab a box.
- What is it? Mass-casualty bins and lots of morphine.
How much longer? - Soon as I get this.
What happened? - Helicopter crash.
- Up on the roof? - In the bay.
- Any survivors? - I don't know.
Find out.
Go! - I closed us to internal disasters.
- What should I do? Grab this gurney.
Okay.
Put one of these on every patient.
Fill in vitals, injury and tear off the triage category.
- Morris! - Romano told me to wait here.
Green for minor, yellow, delayed, red, immediate, black, dead.
Green and yellow stay in Chairs.
Bring back red.
- What about black? - Cover with a sheet.
- Where should I start? - Anywhere.
We need two more gurneys.
How bad is it? - You okay? - Just a little dizzy.
Backboard! - Did they pull anyone out? - No.
Meet Reina Flores.
Came in for heart failure, and now she needs ortho.
It hurts quite a bit.
Abby, morphine.
- What about him? - I'm fine.
Take care of her.
- Chest pains, broken ribs.
- Abdominal pain and weak pulse.
Abby, I need four of morphine.
Susan, you should go inside.
We got this covered.
No, her lungs are wet.
She needs a nitro spray 40 of Lasix and dopamine to keep her systolic above 90.
Are you all right, dear? Yeah, it's just the smoke.
Hey, get me out of here! - Get me out of this! - You're okay, Mr.
Garland.
- We have to move patients to the ER.
- No, they'll be swamped.
- We can treat them here.
- I'll call down for help.
No.
The phones are dead.
- Get him to the other side.
- I can't find the key.
You're gonna be okay, ma'am.
Not if I don't make it to my granddaughter's wedding.
- When's that? - Two weeks.
Hypotensive with a rigid belly.
- Call Corday.
- Blunt chest, good vitals.
- Okay.
- How is my wife? - Who's in charge? - Dr.
Lewis.
Right here.
The fire's just about out.
I got nothing for you.
But I got four for the coroner.
You know, Luka's on.
I can get him to cover for you.
No.
Abby, respiratory arrest in Curtain 1.
- Hey, nurse, I'm chained to the wall here.
- Double up the patients, two per slot.
- I need some help over here.
- Get an E cylinder before you move them.
The fire melted her ET tube.
I have to reintubate.
Burned her central line too.
Come on, get me loose.
Get me loose.
- Here you go, 8-0.
- Not ready for the tube yet.
You wanted to intubate.
I think she aspirated the end into her lungs.
- I need something to fish it out.
- You want a McGill? Keep pressure on it.
I'll find something.
Somebody help! - Ready with backboard and splint.
- One more time.
How are you doing, Reina? Better than the poor souls in that helicopter.
- Pulse ox down to 88.
- Put her up to 10 liters.
- Susan.
- Kerry.
Susan, are you okay? - Were you hurt? - No, no.
I'm fine.
Okay, who are the other Attendings? Luka and Romano.
I don't know where they are.
Can't get tied up with a patient.
Gotta keep your eye on the big picture.
Chuck's on the chopper.
- Oh, God.
I'm so sorry.
- She's more hypoxic.
- How's your breathing, Reina? - We're having 212 wedding guests.
Can you imagine? - She's altered.
Needs an airway.
- Both traumas going to the OR.
- Stay with Lewis.
- Flail chest.
- Okay, Trauma 2 with me.
- Got it.
Abby, you and Pratt take the yellows to Exam 3.
Pulse ox dropped to 88 on five liters.
- Is there blood in the belly? - That's my wife.
We're taking her up to the OR for an ex-lap.
- Berta.
- She's in good hands.
- Happy Thanksgiving, Dr.
Weaver.
- You too.
- Didn't get past the relish tray.
- Tough one.
Had to tube this lady on her side.
Hey, Pratt, you're with us.
- Know how to débride? - I've done it once.
- Let's go.
- What happened? - I don't know.
- Bad concussion.
- Neuro checks Q 15.
- I fell to my hand.
- You lifted patients like that? - Yes.
- You are one tough muchacha.
- Need a doctor here! - All right.
- Through-and-through penetrating neck.
- I tubed him for an expanding hematoma.
- On the roof? Weren't you the flight nurse? - Supposed to be.
- Lily, Trauma 1.
Five hundred cc's in.
- You started a line? - Yeah, in case he needed blood.
- Is that Mel? - Yeah, type and cross for six lateral C-spine, and let's get Surgery down here.
- Nice and easy.
- CO2 detector is yellow.
- We need to tube you too? - I thought he was dead.
How long until we check an ABG? Baby, I had to tube this guy, and there was no suction- Whoa, hey.
- It's not that big a deal.
- I thought you were on the chopper.
Brought their own flight nurse.
Bitch wouldn't let me fly.
- That bitch saved your life.
- Dr.
Lewis! - Multifocal PVCs.
- I know, I know.
I thought you were dead.
Hey, hey.
I scraped my back a little, see? Okay.
- McGill won't fit through.
- All we have.
- Need something thinner.
- Like what? Anything.
- Dr.
Kovac, I need you over here.
- Where are your doctors? Coming from home.
It's Thanksgiving.
- I'm so late.
Gotta call a neighbor.
- Can we focus on this? Curved vascular clamp.
- Get ready with the ET tube.
- Tube her fast.
Sats are dropping.
- Bag her.
- This guy needs the OR.
If we still have one.
Keep pressure on the liver.
- Where are you going? - To the OR.
We need Vicryl mesh.
Okay, and bring a surgeon.
- A little cold on your chest.
- Har- Hard to breathe.
- Because you collapsed a lung.
- How is Berta? She's in the OR.
We'll get an update.
- You have a Cordis introducer? - What's going on, Pratt? Penetrating neck developed a dense left-sided paralysis.
- Vascular needs to repair his carotid.
- No, that won't work.
- Ten blade.
- Call Surgery.
- The injury is too high.
- Yeah? Let them decide that.
-32 French.
- Get me a C-arm and a radiologist.
- No, your patient needs to go to the OR.
- He'll be dead by then.
- V-tach.
- Charge to 200.
Don't do it, Pratt.
Clear.
- Run of six.
- That's another 50 of lidocaine.
She's about to arrest.
Where's the heliox? - Mix it up.
- You think it's rhabdo? Yeah, the crushed muscle cells are getting into her central circulation.
- She needs an amputation.
- Operation would kill her.
Heart's too weak.
- I don't know about that wedding.
- I need ice, lots of it.
Subtract seven from 100.
- Ninety-three.
- Seven from 93.
- What are you doing? - Mental-status exam.
Serial sevens.
Neuro checks are pupils, orientation, grip strength.
Ten other patients need you.
- Excuse me.
- Eighty-six.
Good enough.
We have a foot lac to suture before it's six hours old and- - Chuck? - What is it? Chuck? Move the arm guy into a chair.
Neela, go get a doctor and a SonoSite.
Lester, help me lift him.
One, two- Wait.
Hold it.
Hold it.
Hold it.
Okay, roll him.
- Suction.
- Open the internal paddles.
We need a doctor in Exam 3.
Try next door.
Start internal compressions.
- The guy is stroking out.
- I'd start with an angiogram.
Injury's at the base of the skull.
Surgeons can't get distal control.
- Dr.
Pratt, can you come to Exam 3? - Does it look like it? You don't put a stent in this guy, he's gonna die.
I'm taking the SonoSite.
Clear.
- Ultrasound, but no one's available.
- Hard to bag.
Try a jaw thrust.
- He stopped breathing? - Yeah.
He needs intubation.
Prep an 8-0 ET tube.
Abby? - The damn cords are too anterior.
- You want me to try? Roll him.
Roll him.
Roll him.
Yankauer.
His sats are dropping.
Why isn't this? Can you turn it on? Turn on the wall suction.
-Heart rate's down to 40.
-Okay, stand by with atropine.
Maybe you need a straight blade.
- Give me your hand.
- I'll open the crash cart.
Backwards and to the right.
Right there.
Hold it right there.
Got it.
Bag him.
Neela, tape.
He's got a laceration on his back.
It could be an entrance wound.
Sats are coming up.
Looks like he has a metal fragment in his spleen.
Lester, get me the rapid infuser and two units of O-neg.
What are you doing? - He needs a central line.
- Shouldn't an Attending be here? Yep.
See anyone around? - The liver is wrapped, still bleeding.
- Purse string it with 2-0.
- How do you know this? - I used to be a surgical tech.
- Oh, my, what have we here? - Liver lac.
- Hemostasis with Vicryl mesh.
- Excellent.
Well, I've got an open OR.
Let's get him upstairs.
- Looks like I'll eat cold turkey.
- What time is it? - Almost 5.
- Oh, man.
- Hey, you got a bolt cutter? - Not up here, but I'll get you one.
You're lucky, Mr.
Garland.
- Your burns are only minor.
- I liked it better downstairs.
Only had pneumonia downstairs.
Charged to 30 and clear.
- Asystole.
- Resuming compressions.
- How long's it been? - Thirty-five minutes.
Okay, that's it.
Time of death: 17:09.
Close the thoracotomy, find the family.
His wife's in surgery.
- Hey, what did Vascular say? - They never came down.
There you go.
Leave 3 centimeters to cover the defect, one intracranial.
- Stent is in place.
- What did I tell you? - To do the right thing.
- No.
I want- Hey, look at this.
Motor function in the upper extremity.
Blood flow is restored to the brain.
Everything's good, Mel.
Where's Dr.
Lewis? Clear.
- Sinus tach.
- Got a pulse.
Try for a pressure.
- Reina? Open your eyes.
- You think she'll wake up? - I hope so.
- We still need an Attending.
- Which patient? - The flight nurse guy.
- Chuck? - What? Abby? Occult splenic injury.
Slow leak, took him an hour to drop his pressure.
He's intubated with a central line.
Who did this? Sign here, we can say you did.
- It was either that or let him die.
- This the spleen for the OR? - Yup.
- It's Chuck.
- What, your ex-husband? - Yeah.
- Do you want to observe? - I can't, but I can bring him up.
Last crit was 26.
He's type and crossed for another four.
- BP's 110/70 after two units.
- Abby, thank you.
Is it over? Did he drop his pressure again? Any additional transfusions? - Okay, good.
Thanks.
- Chuck? He's doing well.
They're closing.
- And we're opening to Trauma.
- What? Sent nine to the OR, five to Telemetry four to Med-Surg, and I have monitored beds.
Too bad it takes a disaster to whip this place into shape.
- Ruptured globe's going up to surgery.
- Okay, good.
Abby.
The fibroids involved the uterine artery.
I attempted a myomectomy, but there was no way.
- You did a hysterectomy? - Yeah.
She's stable now.
Heard you had your hands full down here.
Good night.
- Hey, can I sign out? - What? - You're a night-shift nurse.
- Not until 7.
- Well, it's a quarter till.
- I don't believe this.
- I wrote these orders six hours ago.
- Hey, Mom.
- Where's Helene? - She couldn't pull in.
Are those body bags out there? Did you see the crash? Well, looks like home cooking's out of the question.
You wanna go to Ike's? - Ike's? - It's across the street.
We're going out.
You're still coming, right? - I don't think so.
- Why not? - Alex, we'll be fine on our own.
- Mom, you said I could bring a friend.
Besides, it's boring if it's just us.
You're welcome to join us.
- No, I don't have to.
- No.
Come on.
Are you ready? - Yeah, last stitch.
- Where is Romano? - Haven't seen him.
I need to get this- - Let the nurses handle it.
Come on.
Why in God's name would he insist on meeting tonight? - I really couldn't say.
- Time for our little sit-down.
- I'm a little tied up in here.
- Where is Robert? - I thought he was up in the OR.
- I thought he was down here.
- Just fill me in later.
- Come along, Dr.
Pratt.
Best if we deal with this right now.
Romano sent me a file of your disciplinary letters.
Sometimes we don't see eye to eye.
Well, there's enough documentation here to merit a suspension, I guarantee you that.
Offending patients, contradicting consultants refusing to comply with Attending's treatment plans.
Do you care to respond? - Look, I may have been out of line- - Oh, baloney.
- Excuse me? - I give no credence to these allegations.
If any of this were true, I'd get complaints from other Attendings.
And obviously, Robert doesn't care enough to even show up.
I saw you in action today.
You're an excellent physician.
Thank you.
Give this to Romano when you see him.
- Can I have French toast? - No.
Why not? It says all-day breakfast.
Because it's Thanksgiving.
You're having turkey.
Would you rather have French toast or turkey? I don't like French toast.
Why not? You like pancakes.
- Yeah.
- So- So does my mom.
You guys can have pancakes, I'll have French toast and then we can share some turkey sausage.
Alex.
- Why would you do that? - Payback.
I'm sorry I didn't get home in time to cook you Thanksgiving dinner.
Excuse me.
I'll wash up.
Why did you invite him? Because he's my friend.
You shouldn't have friends who are over 30.
- Why not? - Because you're a kid.
So? I like him.
He's cool.
- I know what you're trying.
- I'm not.
And I'd rather not go out with someone right now, okay? You're probably not his type.
Besides, he's my friend, not yours.
Hello, Mrs.
Marshall.
I'm back.
- The nurse never came with my medicine.
- That's okay.
I'm your nurse now.
I thought you were my doctor.
That was this morning.
Now I'm your nurse.
- This is a very strange hospital.
- Tell me about it.
Abby, I'm about to suture an arm lac.
-5-0 nylon.
- I thought so.
How much angulation is acceptable on a fifth-metacarpal fracture? More than 60 degrees needs reduction.
Do you know who gets the Blue Beacon admissions? Sessa, beeper number 2956.
Never received? No way.
I brought that down myself.
Look, I looked in the records room, and it's not there.
Yeah, well, happy Thanksgiving to you too, jagoff.
- Hey, did Detroit win? - I have no freaking idea.
- What about Dallas? - Don't make me come over and smack you.
One for Dr.
Pratt.
Hey, Morris.
What have you been doing all day? Romano told me to wait here.
So you just sat on your ass through a mass casualty? - Yeah.
- Your shift's over, man.
Go home.
I can't.
Are those from Christmas? - Last year? - The year before.
Dr.
Greene.
- Which one's Dr.
Greene? - I'm gonna need a massive amount of caffeine to make it to sunrise.
Here you go, Abby.
Shred it.
Look at this one.
That's definitely 2001.
The Secret Santa party.
- Anybody hear from Carter? - He sent a postcard about a month ago.
- You should put that up in the lounge.
- How's he doing? I don't know.
What are you thinking about? Nothing.
Come back to bed.
Hey.
Hey.
I should fake my death more often.
I knew it.
What? That we'd end up together tonight.
This your idea of a hot date? Yeah, yeah.
It's dark.
All the nurses are busy.
You just had your spleen removed.
Yeah.
You know what they say: When you lose an organ, the other ones get stronger.
Hey.
What are you still doing here? Waiting on a few labs.
I hate to pass on patients when it's busy.
That will change.
Today was pretty amazing.
I've never seen anything like it.
I didn't think we could handle it, but we did.
We did really well.
We saved lives.
It was like a roller coaster.
I've always hated roller coasters, but - I sort of can't wait for the next ride.
- As long as it's not in the next 12 hours.
You drink coffee? I'm not in the club.
I got an extra.
Thanks.
R.
Previously on E.
R.
- What are you doing? - Cut it out! - What are you doing? - He just grabbed my ass.
What are the odds we're gonna find someone better? We should spend either all our time together or none at all and I'm kind of leaning towards none at all.
- Sign it.
- This goes up to Human Resources? Stays with me, until I have a fat enough file to pull the trigger.
Bang! E.
R.
10x08 "FREEFALL" Sinus tach, 130.
BP's up, 220/140.
- Come on.
He's gonna blow an O-ring.
- Let's try Nipride.
- Oh, how did the paramedics miss this? - Cocaine? - Could be.
- Hold the Nipride.
He needs a beta-blocker.
Five of metropolol, IV push.
Heart rate's up to 140.
- Metropolol's in.
- He's seizing.
Okay, two of Ativan.
What are the physiological effects of cocaine? - A sympathetic stimulant.
- Alpha or beta? - Both.
- V-tach.
- Starting compressions.
- Charge to 200.
Check for pulse with compressions.
Clear.
V- fib.
Charge to 300.
- Amp of epi.
- Beta-blocker made him worse.
Clear.
No change.
-360.
Maybe he's allergic.
- I doubt it.
By blocking beta, you left alpha unopposed.
BP's high and his brain's bleeding.
Clear.
Asystole.
- Amp of atropine.
- What should she give? - Phentolamine, esmolol.
- Gold dot for your forehead.
- I've seen beta-blockers work.
- You have nursing experience meaning you can handle - Also means you might kill the others.
- He's not dead yet.
- Another amp of epi.
- Forget it.
That's it.
Stop compressions.
Just another dead junkie.
Congratulations, Abby.
You managed to kill the practice dummy.
Okay, reset for the next student.
Shame we have to work the holiday.
- You got family in town? - No.
Your overdose was harder than my dialysis patient with hyperkalemia.
- I need the room to hold an ICU admit.
- Sorry, bad MVA coming in.
- Where do I put him? - Anywhere, long as it's in the hallway.
- Come on.
- Can't you just get me some pills? That wouldn't be safe.
Mr.
Garland has pneumonia with hypoxia.
You need IV antibiotics.
I need to be with my family for Thanksgiving.
They can come and visit you here.
- How was the mock code? - Fine.
- So Romano humiliated you? - I looked like an idiot.
He does that to everyone.
Or maybe I just don't get it.
You'll catch on.
It just takes a little time.
Stay up there, turkey.
Come on.
- Son of a bitch.
- Better call the coroner on that one.
The damn night shift was supposed to do this.
- I'm just in charge of the potluck.
- Well, my yams are in the lounge.
- How many admits are we holding? - You don't wanna know.
No, there's a sandwich in the fridge.
And don't answer the door until I get home.
All right.
See you soon.
- Everything okay? - I had to leave Alex home for the day.
- He'll be all right.
- It's just until 3.
I finally get to make my kid a real Thanksgiving dinner.
Most years I work.
That's Lily's.
- Thought it was the potluck.
- There's a coffee club.
Yeah, you have to pay every month.
- Sorry.
How much? - It's a nurse's coffee club.
Okay, time to stamp out disease.
- Hand lac for Coop.
- Hit me again.
Oh, one per customer.
Asthma for Neela.
- Vag bleeding for Abby.
- Lovely.
And "bugs are crawling under my skin" for Lester.
- Cool.
- Pratt, will you take incoming trauma? Yeah.
Hey, Frank.
What's up with the stupid parade? Put the game on.
Kickoff isn't till 12:30.
My brother-in-law is marching with the Brundy County Sheriff's Posse.
Oh, yeah, what's that? Some sort of clan? - Morris, what do you think you're doing? - Picking up a patient.
You just skipped over bloody diarrhea for eye pain.
- Smile! - Frank.
Sorry, I didn't think this old thing would work.
It was in last year's box.
Couple of shots left.
What do you figure is on there? Romano and Weaver in a compromising position.
I'll get double prints then, just in case.
October 14th.
Six weeks and three days.
- So I'm still pregnant? - We'll check an ultrasound.
How heavy is the spotting? Couple of pads so far.
Are you taking any medications? Prenatal vitamins, AZT, 3TC, indinavir.
- You're HIV-positive? - Yeah, for 10 years.
Never shared a needle, no blood transfusions.
Just a loser boyfriend with too many chicks on the side.
- Anyone here with you today? - My fiancé.
He's driving up from Iowa City.
This guy's the real deal.
- Abby? - Excuse me.
- Three sick calls for night shift.
- Right, sick.
On Thanksgiving.
Call the registry.
We really need someone who knows the floor.
No.
No way.
I'm on all day as a med student.
I only work nursing shifts on weekends.
I can let you off your rotation at 5 so you can take a nap.
- Can you take one for the team? - No.
Fine.
Only if you can't find anybody else.
- Okay.
- Thanks.
So you're not using the eye drops? My nephew gave me an herbal medicine.
What, some sort of homeopathic crap? - Morris, come on, man.
Trauma's here.
- I think it's called Kona Gold.
- Morris, grab some me some 4-by-4's.
- Yeah.
Okay, this is pretty deep.
I wanted to use the carving knife.
She made me use the other thing.
- It's from Germany.
- Morris! Morgan Westbrook, collision with intrusion.
BP 80 palp, pelvic fracture.
O2 sats, 98.
No significant head trauma.
Didn't get altered until he dropped pressure.
On the phone to his doctor when we pulled up.
Drives a Bentley.
Nice.
Okay, prime the rapid infuser.
Come on.
Let's go.
Here we go.
On my count.
How do we tell pelvic bleeding from intra-abdominal? - CT scan.
- If the patient's unstable? Ultrasound? No, suprapubic mini-lap and DPL.
Which you can assist on.
Pupils equal and reactive.
- We got some sewing for you too.
- Can you two handle this? - Oh, I should hope so.
- I need to get back to my glaucoma patient.
- This is a primo case.
- I'm worried about angle closure.
- No hemotympanum.
- I need to check eye pressures.
Equal breath sounds.
- Is he squeamish? - No, just stupid.
- Frank, where are the nurses? - With patients.
I need a chaperone.
Sam, help me with a pelvic? - After I hang blood.
- Can we bring a few patients back? Eventually.
I've done solo pelvics.
I could help, if you'd like.
- That's okay.
Thanks.
- No, we are boarding five ICU players and it's total gridlock.
I'll give you an hour.
Mr.
Garland, looks like you might be with us for a while.
Not a problem.
- What's that? - Turducken.
What? It's a chicken stuffed in a duck stuffed in a turkey.
- Want a taste? - Maybe later.
Sorry.
No, no, it wasn't you.
Just a cramp.
There's a little bit more bleeding than I expected.
And the cervix is open.
Meaning? With the cervix open, you can't maintain a pregnancy.
I'm sorry.
I had a feeling.
I woke up, and something Something was strange.
We've been trying to get pregnant For how long? Loren? Loren? Damn it.
- Can I help you? - This is Abby.
Who's at Admit? - Just me and the food.
- Well, my patient's bleeding out.
I'll see who I can rustle up.
Could use a little help here! - Systolic's 110 after two units.
- Spontaneous eye movements.
- Mr.
Westbrook? - Where am I? You' re at County General.
You got clipped by a tow truck.
Try not to move your leg.
- What do you think you're doing? - Calling my lawyer.
- I'd rather not be treated here.
- May have internal bleeding.
- I'll take my chances.
- Your phone interferes with our equipment.
- Hello.
It's Morgan Westbrook- - Hey, I said no cell phones! Hello, Mr.
Westbrook.
I'm Robert Romano, chief of Emergency Services.
I just got off the phone with our CEO, Peter Fenwick.
- Oh, Peter was in my class at Wharton.
- Yeah, so I heard.
I think your employees need a lesson in customer service.
This one stole my phone.
Well, he's not long for this hospital.
We're taking him up to CT.
Great.
After a few tests, we'll transfer.
- Thank you.
- You're welcome.
You are in excellent hands with Dr.
Corday.
Believe me, I envy you.
Hey.
Come here.
That guy is the biggest real estate developer in Chicago.
- More like the biggest prick.
- When you get a VIP, sometimes- You treat everybody the same.
- He's not stable.
- If he has no organ injuries, I say he is.
You're making a mistake.
Could have ongoing hemorrhage.
My only mistake was to allow you to practice medicine.
You'll compromise patient care to suck up to some rich guy? We will determine if he's able to be transferred- I'm not signing any transfer papers.
You don't have to.
You're no longer on the case.
Great.
My name won't be on your malpractice suit when he dies.
As far as I'm concerned, you don't work here.
- Right.
- No, I'm serious, Pratt.
You just pissed me off for the last time.
Second liter's in.
Pressure's 100/60.
Hey, Loren.
Gave us a little scare.
You passed out from blood loss.
That doesn't sound good.
There can be retained tissue that keeps bleeding.
- Hemoglobin's 9.
4.
- Okay, type and cross for two.
- How do you stop that? - With a D and C.
We clean things out, and then you're back to normal.
Abby.
- Let's get you a fresh gown.
- I'll be right back.
There is no retained tissue.
She has multiple uterine fibroids.
It won't be as simple as a D and C.
You should be careful what you say.
- Most of the time, it's retained- - Not in her case.
Transfuse two units and call GYN.
We have to get this bleeding to stop.
Next time, wear oven mitts when you take out the turkey, okay? Oh, there.
Hey, Frank, what's the score? First quarter, 0-0.
Oh, you're back from the scan? Bilateral pubic rami fractures and a shattered acetabulum.
- Ouch.
- We got Todd Corbett on standby at the Mayo Clinic.
Hey, you think I'll be able to run the marathon next October? I'd say there's a good chance.
That guy could put Humpty Dumpty back together again.
Be right there.
What part of "you're off the case" don't you understand? Looking out for the patient's best interests.
Did you send off another CBC? - Keep it up, Pratt.
- What, another letter in my file? We're meeting with Weaver and Anspaugh.
- On Thanksgiving? - That's right.
Well, I guess it saves you from spending it alone.
- Did you call Psych about your bug guy? - No, he really has scabies.
My asthma girl's worse.
Call RT for heliox.
Lewis, get coverage for Pratt's shifts starting tomorrow.
Complex laceration? I repaired the extensor tendon with a figure of eight.
- Looks nice.
- Very tidy.
Abby, where's the abductor pollicis brevis insert? - You know its innervation? - Smile! My patient needs blood.
Put your dirty clothes in the hamper.
Check your sugar? Timoptic, one drop two times a day.
What about the other stuff? You don't need it.
It's illegal.
Just say no.
- Just say no to what? - Altar boys.
Look at this rack.
- Do I have to? - We gotta treat patients in Triage again.
- Meet them and street them.
- Not so fast, Luka.
Couple of problems in the hall.
Jeffries spiked to 104.
Tylenol, blood cultures and a gram of cefotetan.
When can he go up? - Fifth in line for Med-Surg.
- Mrs.
Paulson's now altered.
- Two tele admits in front of her.
- How are you doing, ma'am? Thirty cc's of lactulose and draw an ammonia level.
And Mr.
Garland's BP is down to 90 systolic.
Start dopamine at five mics.
- Sorry for the delay, sir.
- That's okay.
I like to people-watch.
- Can you help us at Triage? - No.
- Why not? - You gave me an hour's worth of orders.
This is ridiculous.
No beds, no staff and we're doing the work of the entire hospital.
Yep, welcome to my world.
I need hard restraints for Mr.
Garland.
- Garland? He's a pussycat.
- The kind that lock.
Have you ever had any problems with general anesthesia? Hepatitis? No, they check my liver enzymes on the triple cocktail.
I need you to sign a consent form for exploratory surgery and a possible hysterectomy.
- Hysterectomy? - Only as a last resort.
Nobody said anything about a hysterectomy.
It may be our only option if we can't control the bleeding.
No.
I wanna have kids.
- I appreciate that.
- Dr.
Coburn, do you have a minute? Hang two more units and check another hemoglobin.
Why do a hysterectomy for fibroids? - It might save her life.
- There are other options.
I don't justify my approach to a nurse.
- I'm a fourth-year med student.
- We consent for all contingencies.
Are you even going to attempt embolization? That would take hours.
Okay, I'm not sure I'm getting your point.
She's bleeding out.
She's on her fourth unit, not stable for embolization.
And maybe she would be if she wasn't HIV-positive? - What are you accusing me of? - Let me settle this catfight.
Abby, you're wrong.
I'm discussing uterus-sparing procedures.
- On an HIV-positive woman? - Thank you, I can handle this.
- She wants to have a baby.
- Maybe this is God saying, "Bad idea.
" With a low viral load, transmission's less than 3 percent.
And the kid'll be motherless by age 10.
I'll attempt a myomectomy, but I can't make any promises.
- Rotator-cuff tear.
- I thought it was a game of touch football.
My sister-in-law doesn't like to lose.
- Happy Thanksgiving, Dr.
Lewis.
- Excuse me.
Thank you.
Don't thank me.
Thank some dead guy from Mercy.
- Very romantic.
- So you in the mood for some late-night pumpkin pie? - You know what? I'm beat.
- I'll bring the whipped cream.
- Maybe another time.
- You okay? - Yeah, I'm just tired.
- Of me? GSW to the face en route.
Morris, you're with me.
Talk to you later.
Two liters NC, TKO the saline.
Five-minute ETA on the private chopper.
I'm Chuck.
Dr.
Hewitt from Northwestern.
I'll be flying with you.
Hands inside the car, man.
I appreciate everything you've done, Dr.
Romano.
- My pleasure.
- You coming up to the copter? I'd like to, but as you can see, we are completely swamped.
- I don't know how you do it, Robert.
- I guess it's just my calling.
Thanks a lot.
Take care.
Have a good flight.
Thank you.
Hold that elevator.
So you still think there's a chance? - Yeah, I do.
A good one.
- Abby.
Mrs.
Marshall is praying to the porcelain god again.
Okay.
- Reglan and Tagamet.
- My fiancé's coming to the ER.
Okay, I'll bring him up, and I'm gonna scrub in, make sure you're okay.
This is for painkillers.
Keep them.
After 10 years of marriage, I'm immune to pain.
- Helium gets deeper into the lungs.
- I won't float away? No, but you may talk funny.
- Frank, Pedes ICU have a bed yet? - In your dreams.
- Hey, chow line's open.
- I think you forgot something.
- What? - Emesis basins.
- Shouldn't you be on the roof? - No.
Mr.
Moneybags left his Rolex in the Trauma Room.
- Have one of the nurses take it up.
- They're busy.
Hey, Indira, take that up to the helipad.
- How do I get there? - I don't blame you for being scared.
The last thing you need is to lose another limb up there.
Come on, I'll take you up.
- Someone stole my medicine.
- Talk to the hand.
- What kind of medicine? - For my glaucoma.
- Who was your doctor? - Young guy, red hair and goatee.
GSW to the mid-face.
Where the hell is Morris? So about tonight.
It's okay that I'm coming for dinner? What? Alex invited me.
- What is this? - Septic pneumonia patient.
- We don't have any beds.
- Neither do we.
- You said they accepted him.
- You have to call report.
Here is your report: 72-year-old pneumonia patient on cefotaxime five mics of dopamine and six liters of O2.
- He might leave AMA.
- What are you doing? Take it easy.
He's a troublemaker.
- This is really stupid.
- You have more nurses.
We can't take extra patients.
Why not? We do it all the time.
Now you can't send him back.
Are you coming? Dr.
Romano? Here, take it.
- Patient forgot his watch.
- Thank you.
- Keep your head down.
- I know the drill.
This isn't your flight.
Dispatch sent me.
- Only room for two attendants.
- Me and the doc.
No, I have to go.
Insurance requirement.
She's off the flight.
Hey! - What the hell do you think you're doing? - Nothing.
- Give me that.
- It's not what you think.
Get your ass inside, sit down at Admit and do not move until I come get you.
The strap is caught.
- Fine.
Just call the nursing supervisor.
- You're not helping to solve the problem.
No! Open up four ORs and get every surgeon down here.
- Three criticals out here.
- Copy that.
Mike? - Yo.
- O2 and IVs outside.
Let's go.
Lester, we need backboards, man.
- Dr.
Pratt? - From the roof.
- Morris, get busy.
- I can't.
- Decreased breath sounds.
- Weak carotid pulse.
What's open? - Trauma 2.
- Chest tube, ET and two large-bore IVs.
- Send X-ray for a portable.
- Set up a Thora-Seal? No, no.
I need you to triage.
Go.
We got this.
Go.
- Neela, grab a box.
- What is it? Mass-casualty bins and lots of morphine.
How much longer? - Soon as I get this.
What happened? - Helicopter crash.
- Up on the roof? - In the bay.
- Any survivors? - I don't know.
Find out.
Go! - I closed us to internal disasters.
- What should I do? Grab this gurney.
Okay.
Put one of these on every patient.
Fill in vitals, injury and tear off the triage category.
- Morris! - Romano told me to wait here.
Green for minor, yellow, delayed, red, immediate, black, dead.
Green and yellow stay in Chairs.
Bring back red.
- What about black? - Cover with a sheet.
- Where should I start? - Anywhere.
We need two more gurneys.
How bad is it? - You okay? - Just a little dizzy.
Backboard! - Did they pull anyone out? - No.
Meet Reina Flores.
Came in for heart failure, and now she needs ortho.
It hurts quite a bit.
Abby, morphine.
- What about him? - I'm fine.
Take care of her.
- Chest pains, broken ribs.
- Abdominal pain and weak pulse.
Abby, I need four of morphine.
Susan, you should go inside.
We got this covered.
No, her lungs are wet.
She needs a nitro spray 40 of Lasix and dopamine to keep her systolic above 90.
Are you all right, dear? Yeah, it's just the smoke.
Hey, get me out of here! - Get me out of this! - You're okay, Mr.
Garland.
- We have to move patients to the ER.
- No, they'll be swamped.
- We can treat them here.
- I'll call down for help.
No.
The phones are dead.
- Get him to the other side.
- I can't find the key.
You're gonna be okay, ma'am.
Not if I don't make it to my granddaughter's wedding.
- When's that? - Two weeks.
Hypotensive with a rigid belly.
- Call Corday.
- Blunt chest, good vitals.
- Okay.
- How is my wife? - Who's in charge? - Dr.
Lewis.
Right here.
The fire's just about out.
I got nothing for you.
But I got four for the coroner.
You know, Luka's on.
I can get him to cover for you.
No.
Abby, respiratory arrest in Curtain 1.
- Hey, nurse, I'm chained to the wall here.
- Double up the patients, two per slot.
- I need some help over here.
- Get an E cylinder before you move them.
The fire melted her ET tube.
I have to reintubate.
Burned her central line too.
Come on, get me loose.
Get me loose.
- Here you go, 8-0.
- Not ready for the tube yet.
You wanted to intubate.
I think she aspirated the end into her lungs.
- I need something to fish it out.
- You want a McGill? Keep pressure on it.
I'll find something.
Somebody help! - Ready with backboard and splint.
- One more time.
How are you doing, Reina? Better than the poor souls in that helicopter.
- Pulse ox down to 88.
- Put her up to 10 liters.
- Susan.
- Kerry.
Susan, are you okay? - Were you hurt? - No, no.
I'm fine.
Okay, who are the other Attendings? Luka and Romano.
I don't know where they are.
Can't get tied up with a patient.
Gotta keep your eye on the big picture.
Chuck's on the chopper.
- Oh, God.
I'm so sorry.
- She's more hypoxic.
- How's your breathing, Reina? - We're having 212 wedding guests.
Can you imagine? - She's altered.
Needs an airway.
- Both traumas going to the OR.
- Stay with Lewis.
- Flail chest.
- Okay, Trauma 2 with me.
- Got it.
Abby, you and Pratt take the yellows to Exam 3.
Pulse ox dropped to 88 on five liters.
- Is there blood in the belly? - That's my wife.
We're taking her up to the OR for an ex-lap.
- Berta.
- She's in good hands.
- Happy Thanksgiving, Dr.
Weaver.
- You too.
- Didn't get past the relish tray.
- Tough one.
Had to tube this lady on her side.
Hey, Pratt, you're with us.
- Know how to débride? - I've done it once.
- Let's go.
- What happened? - I don't know.
- Bad concussion.
- Neuro checks Q 15.
- I fell to my hand.
- You lifted patients like that? - Yes.
- You are one tough muchacha.
- Need a doctor here! - All right.
- Through-and-through penetrating neck.
- I tubed him for an expanding hematoma.
- On the roof? Weren't you the flight nurse? - Supposed to be.
- Lily, Trauma 1.
Five hundred cc's in.
- You started a line? - Yeah, in case he needed blood.
- Is that Mel? - Yeah, type and cross for six lateral C-spine, and let's get Surgery down here.
- Nice and easy.
- CO2 detector is yellow.
- We need to tube you too? - I thought he was dead.
How long until we check an ABG? Baby, I had to tube this guy, and there was no suction- Whoa, hey.
- It's not that big a deal.
- I thought you were on the chopper.
Brought their own flight nurse.
Bitch wouldn't let me fly.
- That bitch saved your life.
- Dr.
Lewis! - Multifocal PVCs.
- I know, I know.
I thought you were dead.
Hey, hey.
I scraped my back a little, see? Okay.
- McGill won't fit through.
- All we have.
- Need something thinner.
- Like what? Anything.
- Dr.
Kovac, I need you over here.
- Where are your doctors? Coming from home.
It's Thanksgiving.
- I'm so late.
Gotta call a neighbor.
- Can we focus on this? Curved vascular clamp.
- Get ready with the ET tube.
- Tube her fast.
Sats are dropping.
- Bag her.
- This guy needs the OR.
If we still have one.
Keep pressure on the liver.
- Where are you going? - To the OR.
We need Vicryl mesh.
Okay, and bring a surgeon.
- A little cold on your chest.
- Har- Hard to breathe.
- Because you collapsed a lung.
- How is Berta? She's in the OR.
We'll get an update.
- You have a Cordis introducer? - What's going on, Pratt? Penetrating neck developed a dense left-sided paralysis.
- Vascular needs to repair his carotid.
- No, that won't work.
- Ten blade.
- Call Surgery.
- The injury is too high.
- Yeah? Let them decide that.
-32 French.
- Get me a C-arm and a radiologist.
- No, your patient needs to go to the OR.
- He'll be dead by then.
- V-tach.
- Charge to 200.
Don't do it, Pratt.
Clear.
- Run of six.
- That's another 50 of lidocaine.
She's about to arrest.
Where's the heliox? - Mix it up.
- You think it's rhabdo? Yeah, the crushed muscle cells are getting into her central circulation.
- She needs an amputation.
- Operation would kill her.
Heart's too weak.
- I don't know about that wedding.
- I need ice, lots of it.
Subtract seven from 100.
- Ninety-three.
- Seven from 93.
- What are you doing? - Mental-status exam.
Serial sevens.
Neuro checks are pupils, orientation, grip strength.
Ten other patients need you.
- Excuse me.
- Eighty-six.
Good enough.
We have a foot lac to suture before it's six hours old and- - Chuck? - What is it? Chuck? Move the arm guy into a chair.
Neela, go get a doctor and a SonoSite.
Lester, help me lift him.
One, two- Wait.
Hold it.
Hold it.
Hold it.
Okay, roll him.
- Suction.
- Open the internal paddles.
We need a doctor in Exam 3.
Try next door.
Start internal compressions.
- The guy is stroking out.
- I'd start with an angiogram.
Injury's at the base of the skull.
Surgeons can't get distal control.
- Dr.
Pratt, can you come to Exam 3? - Does it look like it? You don't put a stent in this guy, he's gonna die.
I'm taking the SonoSite.
Clear.
- Ultrasound, but no one's available.
- Hard to bag.
Try a jaw thrust.
- He stopped breathing? - Yeah.
He needs intubation.
Prep an 8-0 ET tube.
Abby? - The damn cords are too anterior.
- You want me to try? Roll him.
Roll him.
Roll him.
Yankauer.
His sats are dropping.
Why isn't this? Can you turn it on? Turn on the wall suction.
-Heart rate's down to 40.
-Okay, stand by with atropine.
Maybe you need a straight blade.
- Give me your hand.
- I'll open the crash cart.
Backwards and to the right.
Right there.
Hold it right there.
Got it.
Bag him.
Neela, tape.
He's got a laceration on his back.
It could be an entrance wound.
Sats are coming up.
Looks like he has a metal fragment in his spleen.
Lester, get me the rapid infuser and two units of O-neg.
What are you doing? - He needs a central line.
- Shouldn't an Attending be here? Yep.
See anyone around? - The liver is wrapped, still bleeding.
- Purse string it with 2-0.
- How do you know this? - I used to be a surgical tech.
- Oh, my, what have we here? - Liver lac.
- Hemostasis with Vicryl mesh.
- Excellent.
Well, I've got an open OR.
Let's get him upstairs.
- Looks like I'll eat cold turkey.
- What time is it? - Almost 5.
- Oh, man.
- Hey, you got a bolt cutter? - Not up here, but I'll get you one.
You're lucky, Mr.
Garland.
- Your burns are only minor.
- I liked it better downstairs.
Only had pneumonia downstairs.
Charged to 30 and clear.
- Asystole.
- Resuming compressions.
- How long's it been? - Thirty-five minutes.
Okay, that's it.
Time of death: 17:09.
Close the thoracotomy, find the family.
His wife's in surgery.
- Hey, what did Vascular say? - They never came down.
There you go.
Leave 3 centimeters to cover the defect, one intracranial.
- Stent is in place.
- What did I tell you? - To do the right thing.
- No.
I want- Hey, look at this.
Motor function in the upper extremity.
Blood flow is restored to the brain.
Everything's good, Mel.
Where's Dr.
Lewis? Clear.
- Sinus tach.
- Got a pulse.
Try for a pressure.
- Reina? Open your eyes.
- You think she'll wake up? - I hope so.
- We still need an Attending.
- Which patient? - The flight nurse guy.
- Chuck? - What? Abby? Occult splenic injury.
Slow leak, took him an hour to drop his pressure.
He's intubated with a central line.
Who did this? Sign here, we can say you did.
- It was either that or let him die.
- This the spleen for the OR? - Yup.
- It's Chuck.
- What, your ex-husband? - Yeah.
- Do you want to observe? - I can't, but I can bring him up.
Last crit was 26.
He's type and crossed for another four.
- BP's 110/70 after two units.
- Abby, thank you.
Is it over? Did he drop his pressure again? Any additional transfusions? - Okay, good.
Thanks.
- Chuck? He's doing well.
They're closing.
- And we're opening to Trauma.
- What? Sent nine to the OR, five to Telemetry four to Med-Surg, and I have monitored beds.
Too bad it takes a disaster to whip this place into shape.
- Ruptured globe's going up to surgery.
- Okay, good.
Abby.
The fibroids involved the uterine artery.
I attempted a myomectomy, but there was no way.
- You did a hysterectomy? - Yeah.
She's stable now.
Heard you had your hands full down here.
Good night.
- Hey, can I sign out? - What? - You're a night-shift nurse.
- Not until 7.
- Well, it's a quarter till.
- I don't believe this.
- I wrote these orders six hours ago.
- Hey, Mom.
- Where's Helene? - She couldn't pull in.
Are those body bags out there? Did you see the crash? Well, looks like home cooking's out of the question.
You wanna go to Ike's? - Ike's? - It's across the street.
We're going out.
You're still coming, right? - I don't think so.
- Why not? - Alex, we'll be fine on our own.
- Mom, you said I could bring a friend.
Besides, it's boring if it's just us.
You're welcome to join us.
- No, I don't have to.
- No.
Come on.
Are you ready? - Yeah, last stitch.
- Where is Romano? - Haven't seen him.
I need to get this- - Let the nurses handle it.
Come on.
Why in God's name would he insist on meeting tonight? - I really couldn't say.
- Time for our little sit-down.
- I'm a little tied up in here.
- Where is Robert? - I thought he was up in the OR.
- I thought he was down here.
- Just fill me in later.
- Come along, Dr.
Pratt.
Best if we deal with this right now.
Romano sent me a file of your disciplinary letters.
Sometimes we don't see eye to eye.
Well, there's enough documentation here to merit a suspension, I guarantee you that.
Offending patients, contradicting consultants refusing to comply with Attending's treatment plans.
Do you care to respond? - Look, I may have been out of line- - Oh, baloney.
- Excuse me? - I give no credence to these allegations.
If any of this were true, I'd get complaints from other Attendings.
And obviously, Robert doesn't care enough to even show up.
I saw you in action today.
You're an excellent physician.
Thank you.
Give this to Romano when you see him.
- Can I have French toast? - No.
Why not? It says all-day breakfast.
Because it's Thanksgiving.
You're having turkey.
Would you rather have French toast or turkey? I don't like French toast.
Why not? You like pancakes.
- Yeah.
- So- So does my mom.
You guys can have pancakes, I'll have French toast and then we can share some turkey sausage.
Alex.
- Why would you do that? - Payback.
I'm sorry I didn't get home in time to cook you Thanksgiving dinner.
Excuse me.
I'll wash up.
Why did you invite him? Because he's my friend.
You shouldn't have friends who are over 30.
- Why not? - Because you're a kid.
So? I like him.
He's cool.
- I know what you're trying.
- I'm not.
And I'd rather not go out with someone right now, okay? You're probably not his type.
Besides, he's my friend, not yours.
Hello, Mrs.
Marshall.
I'm back.
- The nurse never came with my medicine.
- That's okay.
I'm your nurse now.
I thought you were my doctor.
That was this morning.
Now I'm your nurse.
- This is a very strange hospital.
- Tell me about it.
Abby, I'm about to suture an arm lac.
-5-0 nylon.
- I thought so.
How much angulation is acceptable on a fifth-metacarpal fracture? More than 60 degrees needs reduction.
Do you know who gets the Blue Beacon admissions? Sessa, beeper number 2956.
Never received? No way.
I brought that down myself.
Look, I looked in the records room, and it's not there.
Yeah, well, happy Thanksgiving to you too, jagoff.
- Hey, did Detroit win? - I have no freaking idea.
- What about Dallas? - Don't make me come over and smack you.
One for Dr.
Pratt.
Hey, Morris.
What have you been doing all day? Romano told me to wait here.
So you just sat on your ass through a mass casualty? - Yeah.
- Your shift's over, man.
Go home.
I can't.
Are those from Christmas? - Last year? - The year before.
Dr.
Greene.
- Which one's Dr.
Greene? - I'm gonna need a massive amount of caffeine to make it to sunrise.
Here you go, Abby.
Shred it.
Look at this one.
That's definitely 2001.
The Secret Santa party.
- Anybody hear from Carter? - He sent a postcard about a month ago.
- You should put that up in the lounge.
- How's he doing? I don't know.
What are you thinking about? Nothing.
Come back to bed.
Hey.
Hey.
I should fake my death more often.
I knew it.
What? That we'd end up together tonight.
This your idea of a hot date? Yeah, yeah.
It's dark.
All the nurses are busy.
You just had your spleen removed.
Yeah.
You know what they say: When you lose an organ, the other ones get stronger.
Hey.
What are you still doing here? Waiting on a few labs.
I hate to pass on patients when it's busy.
That will change.
Today was pretty amazing.
I've never seen anything like it.
I didn't think we could handle it, but we did.
We did really well.
We saved lives.
It was like a roller coaster.
I've always hated roller coasters, but - I sort of can't wait for the next ride.
- As long as it's not in the next 12 hours.
You drink coffee? I'm not in the club.
I got an extra.
Thanks.