ER s10e17 Episode Script
The Student
E.
R.
Previously on E.
R.
If it's a choice between something serious or nothing maybe serious is the way to go.
You still on for dinner tonight? I thought you were dating a teacher.
I am.
Take care, big man.
Please.
Don't go.
I'm gonna have a baby and Chuck's the father.
You're gonna be a grandpa.
- You marrying her? - If she'll have me.
Come on, that's it.
- Hey, what is that? - A little bit of Sikh rap.
- Wait a minute.
- He's stable now.
- But- - If I don't get out, I'll lose it! Do you understand? E.
R.
10x17 "THE STUDENT" Kertzenstein, Lester.
Lester.
Lester, Lester.
- Very polite.
- He should try Pathology.
That way his patients die before he gets to them.
I heard he wants Radiology anyway.
Second tier.
Lockhart, Abby.
- Very strong clinical skills.
- Efficient when she needs to be.
Knows where to spend her time.
Only one still not sure about Abby is Abby.
Does she want Emergency Medicine? As much as she wants anything.
All right.
Rank to match.
Rasgotra, Neela.
- Intelligent, very sweet.
- Studious.
Studious? She's the smartest one on the floor.
Come on.
She could be more assertive.
She has a tendency to hang back, avoid getting into traumas.
- She's cautious.
It's good.
- She's not ER.
She'll be a star in internal medicine or research something using your intellect, but she's not an ER doc.
Since when did intellect become a liability to working in the ER? There was a memo while you were in Africa.
Because I think she's excellent.
She basically saved Frank's life.
She's thoughtful, but she's deliberate.
Is that code for passive and slow? - She's a student.
She's gonna get faster.
- And in four months she'll be a doctor.
I say rank to match.
That's not the consensus.
The consensus is wrong.
Okay.
The NRMP list doesn't have to go out right away.
Carter, change our minds.
At least you have time for your reclamation project.
I'm on a plane to Africa tonight.
- For how long? - About a week or so.
How's Kem doing? Pregnant.
Asked me to fill a suitcase full of Ho Hos.
- Save some for me.
- Need you to sign off on these dispos.
My shift's over.
Fourteen hours isn't enough? Dr.
Carter, 27-year-old healthy male, knee versus circular saw.
- Chuck said he'd wait for you outside.
- Chivalry.
Time of death, 8:07.
- How long has he been here? - Sat in Triage for seven hours.
- And back in a room for the last two.
- Good luck, Carter.
You irrigated, yeah? I was concerned that the lac might extend to the joint.
- For nine hours? - I thought I should wait on you.
You think Ike Ryan's serving burgers this early? I really need a burger.
What is up with you? I think we got a case of sympathetic pregnancy going on here.
Excuse me? I have all the symptoms.
Nausea, gas, increased salivation, cravings.
- I gotta pee all the time.
- You had all that before I got pregnant.
You know, I have to sit down.
Just get me whatever you're getting.
All right.
See, we're together in this.
Morning.
Morning.
- When are you due? - Another month or so.
I love kids.
When my wife was pregnant with ours it was the best thing ever.
- Yeah.
It's pretty great.
- We're divorced now.
Oh, I'm sorry.
Women are never more beautiful than when they're pregnant.
Wish it felt that way.
Hey don't let anyone ever tell you you're not sexy.
Because you are sexy.
Thank you.
Any real man knows that there's nothing better than making love to a round, smooth, nurturing mother-to-be.
I hope you don't take that the wrong way.
- There's a right way? - I didn't mean to offend you.
- You know what? It's okay.
- Can I touch it? - Excuse me? - Your belly.
Can I touch it? - Hey, what's going on? - You know what? We need to go.
- What are you doing? - I was just talking to the lady.
He wanted to touch my belly.
- Is he hitting on you? - Ease up.
I don't see a ring.
- God, my lip.
- Must be the hormones.
It was flagrant assault.
I called the cops.
My lawyer's on the way.
- You molested me first.
- I asked you an innocent question.
- It was not innocent.
- That caveman decked me for exercising my freedom of speech! Long as I'm stitching your lip, you have no freedom of speech.
He was defending me! You didn't need defending.
I was just being friendly.
Order a nasal series and let me know when his x-rays are back.
- What a creep.
- Could have punched him in his teeth.
- That way they can't talk.
- He apologize? - No.
But he called the cops.
- To what? To turn himself in? No.
Come on.
We have to have a little chat.
No, I understand.
You have a great time.
Yeah, next weekend.
- Morning.
- Hey there.
- What's wrong? - It's Alex's birthday tomorrow.
- Yeah, I heard.
- I wanted to throw him a party.
But Austin's his only friend and his folks are taking him skiing.
- Get him a clown.
- Yeah.
Good idea.
What's wrong with a clown? Kids love clowns.
Next time inject five cc's of fluorescein and observe under a Wood's lamp.
I wasn't sure.
Then come find me, don't just wait.
I didn't want to interrupt the meeting.
Neela, we were ranking fourth-year med students in there.
And everybody agreed you're really bright and we like- - Someone spoke poorly of me? - Nobody particular.
- Dr.
Chen? She's had it in for me- - Neela.
You have to be more decisive.
Okay, you have to be more proactive.
They feel I'm too passive? Tell you what, next four hours, you're a doctor.
Carry a minimum of three patients at all times.
Rescue 37, county base, go ahead.
Start workups, order their labs and meds and present back to me only after you put your own plan into action.
- Today, you're a shark.
- Shark? - Keep swimming or die.
- County General, over.
Car versus nursing home medivan.
Getting the driver, two passengers.
Anybody unstable? - Good vitals on all.
ETA, nine minutes.
- Got the first one.
Okay.
So work up these three.
In fact, just work up these two.
That's enough.
And then go help Gallant.
Hey, Mike.
Leaving that stripper in Curtain 4 with the broken toe for you.
- Try not to T.
U.
B.
E.
her.
- What are you talking about? Totally Unnecessary Breast Exam.
Avoid your worst impulses.
- I think you're projecting.
- Michael, hi.
New-onset seizure.
Needs to go to Medicine.
Post-op appy with fever needs a belly CT.
Call me if there's a problem.
- Got you.
- Feel like getting breakfast? Maybe another time.
Deb, lady waiting for you in Triage.
- Gallant can take her.
- It's not a patient.
She's a nurse.
She says she works for you.
Have a good shift, Neela.
Lucia? - Sorry to bother you.
- Something happen with my dad? No.
The night nurse agreed to stay late.
I'm not coming back.
Your father won't wear the diaper.
He throws food at me.
When I try to help dress him, he yells very bad words.
I appreciate your patience.
You know, this isn't really him.
I know he's a very good man, Dr.
Chen, but I can't do it anymore.
If you could just give me a few days until I can get a replacement- Here's my address.
You can send my last check there.
- And give him this for me.
- Lucia I pray for him.
I don't like working on old people or children or drunks.
And what's with all the sick people? They make it such a drag.
He's just motivating you for the match rankings.
You know, maybe they're right.
Maybe this job's just too fast for me.
Too unpredictable.
It's a big hospital.
If ER's not a good fit- Then what? NICU made me wanna jump off the roof.
Pedes is full of screaming brats and parents and ob-gyn's a lifetime of overnights and malpractice suits.
I could go into research or teaching, but is that really why I became a doctor? I'm sorry.
Were you talking to me? This place is so up and down.
I mean, you learn to ride through the rough days.
I did.
- You were probably good from the start.
- Are you kidding me? I came in young, dumb and scared.
At least you You're good with the books.
You really like it here? I wouldn't stay if I didn't.
Luis Sanchez, MVA passenger deformed upper right leg, probable femur fracture.
- No! - Give anything for the pain? - Pressure's too low, 90/70.
- From a nursing home? - Make it stop! It hurts! - Is this a change in mental status? I don't think it's from the crash.
Home said he fell in December.
Can you call my wife? I have a wife.
Figured he had some kind of brain injury.
Lower-extremity fracture, borderline pressure.
Need to rule out intra-abdominal bleed.
Trauma 1.
- Two more MVA's rolling in behind me.
- Okay.
On my way.
- Can we medicate? - Once his pressure's up.
- Here's the SonoSite.
- Two liters of saline wide open.
Maybe we can draw up analgesics? - Luis, do you have any allergies? - I don't know, I don't know.
Are you taking any medications? - Mary gives me my pills.
- What kind of pills? Blue and green and three white.
Morrison's good.
No blood in the belly.
- Pressure's up to 100.
- Morphine? Need a med list and allergy history first.
Make it stop! It hurts! Pocket doppler and Surgilube.
- I don't like - Cole's potassium is 3.
2.
- Forty of K-Dur.
- Suze, I'm not gonna do it.
- Then he'll press charges.
- I have other things.
- We should press charges.
- This is Neela from County.
For having a disturbing pickup line? I need to speak to a nurse.
- I believe the name's Mary.
- Just say you're sorry.
Valproic acid level for Mr.
Bernstein.
Done with your freak.
Give a half bolus, seven per kilo IV.
When will the nurse be available? Can you read me the list from the chart then? - Why not? - Can Mrs.
Herrero eat? Two-gram sodium diet, Sorry you had a bad morning, but Luis Sanchez had a worse one.
So could you please fax us the med list as soon as possible? Screw you! You want it, get your ass How about a magician? Magicians are cool.
Last year he wanted a pig embryo.
You really think a magician's gonna do it? Lucy Kilmer, another van passenger from the nursing home.
History of laryngeal cancer, complains of low back pain.
- Where was she sitting? - Middle row.
- Vitals good, resps 12.
- Any belly pain, ma'am? No, I'm okay.
- Carter needs help with the van driver.
- I have just the thing for him.
Paintball.
Good idea.
Put a gun in his hand.
- Fifty more of fent is in.
- Got a flail segment with hemopneumo.
Betadine and size-eight sterile gloves.
- What do you need? - Tachy at 126.
The guy next door needs meds but there's no drug records.
- Call the nursing home.
- I did.
They'll get back to me.
- You tell them it was urgent? - They seem very disorganized.
I'll need a second Thora-Seal.
You keep paperwork on the patients you drive? He's not breathing.
In-line traction.
Get ready to bag him.
I need a doctor.
Trouble with a trach.
- Carter.
- Neela, go with Sam.
- BP holding at 126 systolic.
- Okay, bag him up.
- Trach's out.
- She must have pulled it.
She needs a new one.
Number-four shiley, uncuffed.
- Okay, I'll call a doctor.
- No, no.
I can do it.
- You need some Surgilube.
- Right.
Okay, ma'am, extend your neck and look up at the ceiling.
On your third breath.
Ready? In, out, in, out.
Big breath in.
- Pulse ox coming up.
- Let's tie it in.
Got it.
Thank you.
Doctors? We don't need no stinking doctors.
- Neela! - She could use some ice chips.
Sats are coming up.
Transport information on the passengers.
Found it in his jacket.
- Go! Go! - Into the pleural space, chest tube's in.
Up to 120.
Discharge summary from the last hospital visit.
- When was it? - Three weeks ago.
Good.
Good enough.
Mr.
Anderson's vomiting blood in CT.
Okay.
Titrate morphine to pain.
Start with four milligrams.
Hemocue's 15.
I don't think he has any internal bleeding.
Stop.
Not the morphine.
Nausea and vomiting with morphine during his last hospitalization.
What do you wanna do? I'll be right back.
- Jerry, tell him.
- It is not unmanly to apologize.
Just do it and let's get out of here.
I'm exhausted.
Okay.
I'm going in.
- Dr.
Gallant go to CT yet? - Yeah, he's there.
Has there been a fax for me? Price list from Crazy Joe's Party Supplies? Who knew piñatas were so expensive? - Damn it.
- Everything okay, Neela? Got it taken care of.
Neela, Mr.
Lavecchia's urine's four-plus for blood.
- Kidney stone, 30 of toradol.
- I pulled Demerol.
No.
Give the Toradol 15 minutes before we try narcotics.
- All right.
I'll put it away.
- No, I'll take it.
Pain scale, eight out of ten.
Give him something.
Discharge summary says he got post-op Demerol.
Good.
How much? Abby, triple-lumen CVP kit? - Go ahead.
I'll take care of it.
- Please.
- Please stop hurting.
Please.
- All right, Luis.
This is going to make you feel much better.
It's so sweet to see them growing.
- Babies? - Men.
Dr.
Lewis, Mr.
Hemorrhoid in 3 is asking for you.
Oh, no.
I'm not here.
I left an hour ago.
- Crazy bastard! Get off me! - Pull his hair! Chuck, stop! Oh, my God.
Stop it, Chuck.
- Get your hands off me! - Come on.
Come on, guys.
- Come on, Chuck.
- Okay.
All right, all right.
It don't hurt no more.
You made it go away.
Isolated femur fracture awaiting Ortho.
No evidence of occult blood loss, vitals stable, medicated for pain.
Good.
Wheezing in Two, sudden-onset visual loss in the eye room.
- Which one should I take? - Both.
Keep it up.
- I never touched the guy.
- Says you handled him aggressively.
- She handled him? - Yeah, in his dreams.
- There are potential lawsuits here.
- You're kidding me.
He's threatened to sue the hospital, Emergency Department city, county and fire department.
- I'm not even on duty.
- I need this to go away.
Either I get the lawyers down here and- No, fine, I will talk to him.
- What? No.
No.
- No, he's weird, he's not nuts.
I will talk some sense into him.
Hernia's trapped outside the abdomen.
That bad? - You ready to round? - Deep breath, Bobby.
- Better? - Yeah, thanks.
A surgeon will come.
Straightforward procedure, nothing to worry about.
- Cool.
- Inguinal hernia? Incarcerated.
Reduced without sedation.
The kid's tough.
Twenty-year-old asthmatic came in with a sat of 89.
On his third albuterol with atrovent, received sixty of pred.
Aeration's improved but still 92 on room air.
- Call Medicine? - On their way.
Can I get some more water? Tiger Lily Lee, 24, cotton mouth.
- I'm, like, parched all the time.
- History of polydipsia led me to check her blood sugar, 642.
New-onset diabetes.
Not DKA yet.
- You should give 10 units- - Of regular insulin two liters of saline, and I consulted Endocrine.
Back to bed.
Great.
You can send it to this address.
- Hey.
- Oh, Neela.
We're on our way out.
- She's looking much better.
- Yeah.
Back to her usual self.
Viral gastroenteritis.
I consulted Kovac as you were too busy.
Thanks for your help, doctor.
Mr.
Silvio, four ounces every hour.
And don't let her chug, because she'll just throw it back up.
Rehydration, avoided IV, out in an hour.
The girl is on fire.
- Yeah, you told us so.
- I told you so.
- Told you what? - Nothing.
Attending gossip.
- Hey, did you check out the van driver? - Yes.
He needs an exploratory laparotomy.
We're moving him up.
So? His lungs re-expanded, No, no, no.
Not that.
Last night.
The surgeon.
Oh, it was splendid.
Is that British for sweaty and hot? - I don't kiss and tell.
- Abby.
Radiology's bouncing back your patient.
His temp's up and he's unresponsive.
- I'm gonna need some dirt later.
- Our gift shop sucks.
Couldn't find anything? Novelized version of The Matrix Reloaded.
I had them fax over a menu so you could see.
Mr.
Hyde's Tavern.
It's a haunted-mansion restaurant.
Strawberry blood shake? Tarantula fries? That's cool, right? I want it to be something he'll remember.
Special.
What? A blood shake's not special? This is Frederika Torrez.
Hurt her ankle during tennis team practice.
- Who put this on? - Sister Margaret.
She's my coach.
- Did she come with you? - She's out in the waiting room.
Did you roll it inside or out? - I can't really remember.
- The toenail's bruised.
Did you do anything else besides twisting it? I don't think so.
Are you sure you didn't jam your toe or kick something? Okay.
There's this really creepy guy who keeps on flashing us during practice from outside the fence.
You know, opening his coat, and he's naked underneath.
I mean, totally.
- It's really gross.
- Yeah, I bet.
Sister Margaret called the cops but he got away before they showed up.
So today we just got sick of it.
We all ran after him and got some whacks in before he got away.
You beat this man up? Sister Margaret also teaches us self defense.
She's cool.
How bad did you hurt him? I'm pretty sure we kicked his ass.
Need a little help here.
He's unresponsive.
Temp's 105.
8.
- He didn't have a fever before.
Luis? - He needs a septic workup.
CBC, blood cultures times two, cathed UA, spinal tap? - Rule out encephalitis and meningitis.
- Oh, no! - All right, roll him.
- Ativan? - Four mgs.
- Push it.
Is he on phenothiazine? - What does the medical record say? - I'll see if it came in.
You didn't get it yet? - Headache's worse.
- I'll get you another shot.
- Did you look at my x-rays yet? - Soon, Mrs.
Jenkins.
- Slow down, you're showing us up.
- Luis is seizing.
- Who? - Brain injury guy.
- I thought he was stable.
- Not anymore.
- Six of Ativan on board.
- Another gram of Dilantin.
- Med list.
- Why didn't you have it? Fax wasn't in.
Driver's record was only three weeks old.
All right, read it to me.
Baclofen, omeprazole, Keflex, tolderodine.
The only thing new is his anti-depressant.
Phenelzine? - Monoamine oxidase inhibitor.
- What did you give him? - Morphine.
- Need to think about an airway.
- No, Demerol.
- You gave Demerol? - He had nausea with morphine- - Serotonin syndrome.
- What? - Never give Demerol with an inhibitor.
- It can be fatal.
- Let's get him on O2, 15 liters.
Okay, spinal tap.
Come on, prep a drape.
Your better half got that idiot to drop the whole thing.
She did? What do we have to do? You don't have to do anything.
- You mind if I lift your shirt up a bit? - Don't push your luck, creep.
You are dead.
Don't worry.
I'll get Chuny to put battery acid in his IV.
Hey, Jerry, will you check on my x-rays? What's up with you? I defended Susan from some freak.
And ended up getting her molested.
I can't watch this anymore.
George Deakins, mugged under the Michigan Avenue Bridge.
Lovely day.
You'd think you could take a walk by the river.
- Could you remove your coat, please? - I'd rather not.
In order to examine you, I need to listen to your chest.
It's all right, George.
They steal your clothes? Yeah.
Okay, get him a drape.
Cocktail napkin ought to do it.
So they scratched you up pretty good.
How many guys were there? Must have been, like, four or five.
With long nails and a tennis racket? So, George you're a sports fan? - Fluid looks clear.
- BP's sky high, 220/140.
Start an esmolol drip.
- Hypertension part of the syndrome? - Who pushed Demerol for you? - Nobody.
I did.
- There was no nurse? - I was called out.
- It's not Abby's fault.
I'm capable of pushing pain meds.
Shouldn't push without a history.
- I didn't wanna wait.
He was in pain.
- Who did you speak to? - The receptionist.
- So you didn't actually talk to a doctor- - Dr.
Carter- - I couldn't.
No.
You can't take no for an answer when you have an unstable patient.
I gave her the order.
I thought you said morphine.
Neela saw it was contra-indicated, so I changed it.
And what? You forgot? I was a bit preoccupied.
Had someone crashing in CT.
- Dr.
Gallant- - Myoclonus and hyper-reflexia here.
Isn't there a serotonin antagonist we can give him? - We just have to wait.
- For what? To see if he lives.
When can I go? Talk to the police first.
The police? About my mugging? Yeah.
- Still haven't left? - I don't wanna talk about it.
I am going to kill you.
Baby, please, I am sorry.
Listen.
Come on.
Don't be like that.
Who knew that guy was such a whack? How does a guy get to be such a freak? - Born with a Y-chromosome? - Oh, so all men are twisted? - You said it.
- You hate men? If it weren't for sperm and heavy lifting, you'd all be useless.
I can't wait to pop this baby out so men will quit looking at me like I'm Mother Teresa or the Maxim cover.
It's not just men.
The world is full of degenerates.
Yeah.
And the sad part is they always get away with it.
Get him! Get him! Get him! Temp's still up, 104.
Another 200 of IV dantrolene.
How come there's no written order? - We were busy.
I called it out on the run.
- Demerol, 50 milligrams IV push.
Verbal order at 10: 23.
Dr.
Gallant, can I speak with you for a moment? - You're right.
It was more like 10:45.
- Pulse ox down to 82.
- He's not moving any air.
- Too much Ativan? Or neurologic damage from hyperthermia.
Let's open an intubation tray bag him on 100 percent.
- His wife and daughter are here.
- Suction's ready.
Call Respiratory for a vent.
- Sats are up to 89 with bagging.
- Take them to the family room.
Neela, you're doing the tube.
Let's go.
Welcome to the perv ward, Mr.
Deakins.
- You put me in a special room? - Don't worry.
They're all special.
Pervert's a relative term, honey.
Call me honey again, I give you the longest Foley catheter in the world.
Neosporin to the lac.
BID.
So I've got our problem solved.
- Alex's birthday party.
- Thanks for the help, Luka.
But I think it's my problem.
You see, that's your first mistake.
Anyway, a plan is in motion, arrangements are being made and everything is under control.
Keegan's CBC isn't back yet and I need a head CT on Hong.
Do me a favor? Check my departure time? - What, are you flying through Paris? - Amsterdam.
Hello! - Frank.
- Hey, Frank.
- What's up? How are you? - Thought I'd stop on my way from rehab.
- How's that going? - How do you think? They split me open like a Montana trout.
You don't just bounce back, you know? - Wanna see my scar? - No.
Guy in Two might wanna touch it.
- You look good.
You do.
- I can do two miles on the treadmill.
I haven't been able to do that since, well, ever.
- Where are my last two paychecks? - Been holding them for you.
- Where? In your wallet? - When are you coming back? I don't know.
Rehab's like a vacation, my old police benefits are a charm I don't really miss this sideshow.
- Is Dr.
Pratt around? - He's off today.
- Tell him I owe him a beer.
- Sure thing.
My doctor's not ready for me to come back to work yet.
It's gonna be a while.
But I do miss everybody.
I just wanted to say that.
Four-year-old, left upper quadrant pain.
Found with shortness of breath, confusion.
He kept asking for me even though I was standing right there.
- Tachy at 144, resps 42.
- BP, 86/55.
- When did your tummy start hurting? - No, Mommy, no.
She's on her way, buddy.
He's not making any sense.
- Any medical problems? - No.
Always been healthy.
Seventy-seven systolic.
- How are you doing, Tevin? - I don't like horses.
He's altered.
Have an intubation tray ready and squeeze in those fluids.
- Do you know what this is? - Your son's spleen is enlarged.
It may be acting like a sponge, soaking up his blood so it can't circulate.
So, what can you do to stop it? Hopefully transfusions will keep him stable until we know the cause.
First liter in.
Pulse in the 70s.
Okay, keep the NS coming.
Femoral-line kit.
I'm with him every day.
I take care of him.
Nothing like this has ever happened.
Does your son have a history of thalassemia or sickle cell disease? My wife has the trait, I tested negative.
I wanna go on a Ferris wheel.
As soon as you're better, buddy.
I don't know what that other thing is.
Thalassemia.
It's a hereditary anemia.
Here you go.
Talking to him's the best thing you can do.
Blood's here.
Line's in.
Run them on the infuser.
Occult trauma? Should we call in social work? I don't know.
Could be malignancy, hemoglobinopathies- - That's some differential.
- Yeah.
Add a sickle screen and HIV to the labs.
We didn't realize Luis was recently put on phenelzine.
An interaction between the drugs creates the condition serotonin syndrome.
You get very sick.
Like when they gave him the morphine? Worse.
You get high fever, high blood pressure, rapid heart rate, muscle spasms.
- How long does that last? - A few days at least.
But it's very serious.
Up to 30 percent of the people with serotonin syndrome die from it.
- So 70 percent survive? - Yes, ma'am.
They didn't think he'd ever wake up after the fall, but he did.
Good.
Good.
That means he's a fighter.
He's really smart, you know? I mean, he was gonna go back to school before the accident.
Then I got pregnant again.
My dad hired him on at his roofing business.
Don't usually work when it's icy.
But there was a job that he wanted to finish before Christmas.
- Why say you did this? - It doesn't change anything.
- I'm partially to blame.
- It's okay to lie? - Do you want to match or not? - Only if I deserve to.
You do.
So let this be my fault.
Patellar dislocation in Curtain 4 needs a reduction.
- How's Luis? - He's stable.
It's looking pretty good.
- Is there something I should know about? - No.
You did what you were told.
Gallant's supervising resident.
Should have known not to order up a drug without a medical history.
He didn't.
I did.
You ordered the Demerol? I assessed it, I ordered it, I pushed it.
And you didn't run it by an Attending or a Resident? - No.
- Because I asked you to be autonomous? Found an Arabic interpreter for your belly-pain lady.
Thank you.
All right, we need to talk about this, the three of us.
- Everything okay? - Fantastic.
Oh, Lavecchia's results.
Kidney stone from this morning.
No hydro, pain-free with Toradol and ready to go home just like you said.
Didn't need the Demerol after all.
Still have the vial? - I'll put it back in lockup.
- I used it for a patient.
Sam, did you get labs back on Tevin? - How's Tevin doing? - He's doing much better.
- I wanna go home.
- Mr.
Walker.
Hey, wanna pick out a sticker? Tevin tested positive for sickle cell anemia.
That's impossible.
I told you I don't carry the gene.
Maybe there was a mistake with your test.
Maybe there was a mistake with your test.
What your son has, splenic sequestration, is consistent with sickle cell.
A form that's very manageable.
You're not listening.
I told you I went to a genetic counselor.
He said I'm not a carrier that our son could not get the disease unless both parents are.
That's true.
So what? You're saying I'm not his father? What I'd like to do is send his blood for a more advanced test.
Just to be sure.
Send my blood too.
Test me again.
Neela.
Carter wants to talk to me after my shift.
- I told him what happened.
- You what? I didn't think it was right for us to lie about it.
Nobody needed to know.
That was the point.
Please, someone! Please help! Something's wrong! He went into V-tach.
Unsuccessful cardioversion at 200.
- Get him off the vent, bag him! - Please.
He can't die.
Charge to 300.
Clear.
No change.
Try 360.
- Need any help? - Amp of epi after the next one.
- Charged.
- Clear.
- V-fib, 100 of lidocaine.
- This is not supposed to happen.
Go and find Dr.
Carter now.
- Let's go, 360 again.
- Clear.
Come on, hit him again, 360.
Clear.
- Still in fib.
- Three sixty again.
Clear.
Asystole.
- How long has it been? - Shall we try the high-dose epi? Forty-two minutes.
Run the dopamine.
We still have time.
- Or we can pace him.
- Neela.
- Let's try pacing him.
- Tie off the lines leave the ET for the coroner.
Carter, inform the family and then meet us.
Are his tests back? They confirmed my diagnosis.
The good thing is most kids do very well with folate and prophylactic antibiotics.
Good.
That's good.
I also ran your blood through.
- The tests indicate that- - Is there anything affecting my health that I need to know about? Not really.
No.
All that piece of paper is gonna tell me is whether or not he's got my genes.
Either way, he's still my son.
I'm his father.
From a medical standpoint, it's a bit more complicated.
Liza My wife and I, we We went through a rough patch about five years ago.
We broke up for a few weeks.
She got pregnant right after we got back together.
We've been happy ever since.
She's gonna want to know about Tevin's condition.
I'll tell her that I'm a carrier.
He got it from both of us.
And he's gonna be okay.
He's in here, Mrs.
Walker.
- Honey, is he all right? - He's fine.
He's fine.
Did you get his labs back? - Is he the father? - Yeah.
Hey, I didn't mean to keep ragging on your suggestions before.
Maybe Mr.
Jekyll's isn't a bad idea.
Mr.
Hyde's.
Look, I know I'm not exactly Carol Brady.
So I really wanted it to be special.
It will be.
Be ready to go in a half-hour.
I have to pick something up, okay? Was the med list current? I think we should stick to protocol.
As the Attending, I'd like to review this with my staff before we do this.
Was the med list current or not? It was recent.
It wasn't completely up to date.
And no one checked with the nursing home? - I tried.
- You tried? - Abby, why didn't you push the meds? - I was called out.
But the result wouldn't have been any different.
As the nurse, it's your responsibility to double-check allergies and interactions.
I thought that had been done to the- It's a case of managing a patient's pain with incomplete information.
I suspect a jury won't see it that way.
- Who made the decision? - I did.
You did? So now we let medical students push pain meds without supervision? - That's not what happened.
- I was with a patient.
Neela did exactly what I told her.
Actually, that's not- You need a few minutes to get your story straight? What does it say in the chart? Exactly what I've been saying.
I ordered the drug, and Neela pushed it.
And is that accurate? Like I said, I wasn't in the room.
- Simple question.
Is it accurate? - As far as I know yes.
A young man comes in here and dies of a lethal drug reaction that could have been prevented with one phone call.
Next time why don't we just send a blank check to the family's attorney? Mom! Mom! - Son of Sam is back.
- Mom! - What are you doing here? - Luka picked me up.
It's amazing! - We gotta go, though! - Hold on.
I'll take those.
If we hurry, we can get there by 11.
What are you talking about? What are you wearing? Luka said I have to wear a life vest for the boat.
Boat? What boat? Isn't it awesome? It's bigger than our whole apartment.
Wow.
You really went a whole other direction.
A weekend in the great outdoors.
Fishing, camping, burning s' mores.
-S' mores.
Do you know what that is? -White thing on a stick.
Come on, you gotta see inside.
- Wait.
Where are we going? - I rented a spot at Lake Geneva.
Bottom of the ninth, two outs, nobody on and here comes Kovac with a clutch home run.
Is that baseball? How you gonna back this thing out? Mr.
Joss's triple-A repair went well.
He's stable in the ICU.
And Dr.
Edson's finishing up on the perirectal abscess right now.
And do you know a good cheap red wine that goes with spicy food? I have a date.
Two nights in a row.
It's with the teacher tonight.
Okay.
Zinfandel.
I'm not completely comfortable with waking up with one man and going out with another the next night.
Well, if we were guys, we'd be talking about carburetors right now.
So you don't think it's slutty? No.
I just won't sleep with him.
That sounds like a good plan.
- Good night.
- Good night.
Women plan, God laughs.
Hey, when did I become the guru of sluttiness? - Did you start that banana bag on Vern? - Three times.
He keeps going off to the bathroom and coming back drunk.
I think I should delete emergency medicine from my match list.
- One mistake.
I pushed you too hard.
- No.
What they said about me in your meeting was all true.
Look, you're a talented doctor.
And you did a lot of good things today.
Nothing I did on this shift can convince me or anyone else that I belong here.
Yesterday you were a little too cautious.
Today you were a little too reckless.
Somewhere in the middle is the way to practice emergency medicine.
I just want you to know I shouldn't have left you alone with the patient until he was stable.
It's my fault.
What you did was the sweetest, dumbest thing anyone has done for me.
Well, something like this could have derailed your career.
Worst that'll happen to me is discipline, counseling.
I'll be all right.
You don't look all right.
Seems kind of silly now, but out in the bay this morning, I was I was thinking about asking you out.
I was thinking of saying yes.
I have that cefoxitin for Mr.
Martin.
I just need the extension tubing.
- Are you okay? - I'm fine.
I'll take care of it.
- Let me help you find it.
- I said I can do it! Bottom drawer.
Well I suppose it's time to call it a night.
- You're welcome to stay a little longer.
- No, no, no.
I really should get going.
I'll get my coat.
I'll help you find it.
It was such a lovely evening.
And I am so glad that the girls like each other.
Ella's a great kid.
Oh, and it was really good of you to pick her up from school.
Thank you so much.
You want me to carry her to the car for you? No, no.
No, I'm fine.
I can manage.
So good night.
You should have come and talked to me.
You know why I backed you up in there? Because if Weaver knew the truth you'd be done.
I know you went out on a limb for me but I could just say I got confused.
You could have.
Until you falsified the chart.
- But - That's a felony.
Okay.
- Then I gotta go tear it up.
- Too late.
Why? Why? It's just one entry on an otherwise blank order sheet, okay? Nobody's gonna know it's missing.
We can talk to Weaver again.
It's too late! It's already up in Legal.
You know, you guys sit up there and you decide who's gonna go and who's gonna stay.
I mean, why did you have to push her? Why'd you have to push her?! The only reason she screwed up is you made her think she wasn't good enough! She wasn't cutting it! We're talking about you now, Michael.
I wasn't thinking.
I'm sorry.
Yeah.
Me too.
R.
Previously on E.
R.
If it's a choice between something serious or nothing maybe serious is the way to go.
You still on for dinner tonight? I thought you were dating a teacher.
I am.
Take care, big man.
Please.
Don't go.
I'm gonna have a baby and Chuck's the father.
You're gonna be a grandpa.
- You marrying her? - If she'll have me.
Come on, that's it.
- Hey, what is that? - A little bit of Sikh rap.
- Wait a minute.
- He's stable now.
- But- - If I don't get out, I'll lose it! Do you understand? E.
R.
10x17 "THE STUDENT" Kertzenstein, Lester.
Lester.
Lester, Lester.
- Very polite.
- He should try Pathology.
That way his patients die before he gets to them.
I heard he wants Radiology anyway.
Second tier.
Lockhart, Abby.
- Very strong clinical skills.
- Efficient when she needs to be.
Knows where to spend her time.
Only one still not sure about Abby is Abby.
Does she want Emergency Medicine? As much as she wants anything.
All right.
Rank to match.
Rasgotra, Neela.
- Intelligent, very sweet.
- Studious.
Studious? She's the smartest one on the floor.
Come on.
She could be more assertive.
She has a tendency to hang back, avoid getting into traumas.
- She's cautious.
It's good.
- She's not ER.
She'll be a star in internal medicine or research something using your intellect, but she's not an ER doc.
Since when did intellect become a liability to working in the ER? There was a memo while you were in Africa.
Because I think she's excellent.
She basically saved Frank's life.
She's thoughtful, but she's deliberate.
Is that code for passive and slow? - She's a student.
She's gonna get faster.
- And in four months she'll be a doctor.
I say rank to match.
That's not the consensus.
The consensus is wrong.
Okay.
The NRMP list doesn't have to go out right away.
Carter, change our minds.
At least you have time for your reclamation project.
I'm on a plane to Africa tonight.
- For how long? - About a week or so.
How's Kem doing? Pregnant.
Asked me to fill a suitcase full of Ho Hos.
- Save some for me.
- Need you to sign off on these dispos.
My shift's over.
Fourteen hours isn't enough? Dr.
Carter, 27-year-old healthy male, knee versus circular saw.
- Chuck said he'd wait for you outside.
- Chivalry.
Time of death, 8:07.
- How long has he been here? - Sat in Triage for seven hours.
- And back in a room for the last two.
- Good luck, Carter.
You irrigated, yeah? I was concerned that the lac might extend to the joint.
- For nine hours? - I thought I should wait on you.
You think Ike Ryan's serving burgers this early? I really need a burger.
What is up with you? I think we got a case of sympathetic pregnancy going on here.
Excuse me? I have all the symptoms.
Nausea, gas, increased salivation, cravings.
- I gotta pee all the time.
- You had all that before I got pregnant.
You know, I have to sit down.
Just get me whatever you're getting.
All right.
See, we're together in this.
Morning.
Morning.
- When are you due? - Another month or so.
I love kids.
When my wife was pregnant with ours it was the best thing ever.
- Yeah.
It's pretty great.
- We're divorced now.
Oh, I'm sorry.
Women are never more beautiful than when they're pregnant.
Wish it felt that way.
Hey don't let anyone ever tell you you're not sexy.
Because you are sexy.
Thank you.
Any real man knows that there's nothing better than making love to a round, smooth, nurturing mother-to-be.
I hope you don't take that the wrong way.
- There's a right way? - I didn't mean to offend you.
- You know what? It's okay.
- Can I touch it? - Excuse me? - Your belly.
Can I touch it? - Hey, what's going on? - You know what? We need to go.
- What are you doing? - I was just talking to the lady.
He wanted to touch my belly.
- Is he hitting on you? - Ease up.
I don't see a ring.
- God, my lip.
- Must be the hormones.
It was flagrant assault.
I called the cops.
My lawyer's on the way.
- You molested me first.
- I asked you an innocent question.
- It was not innocent.
- That caveman decked me for exercising my freedom of speech! Long as I'm stitching your lip, you have no freedom of speech.
He was defending me! You didn't need defending.
I was just being friendly.
Order a nasal series and let me know when his x-rays are back.
- What a creep.
- Could have punched him in his teeth.
- That way they can't talk.
- He apologize? - No.
But he called the cops.
- To what? To turn himself in? No.
Come on.
We have to have a little chat.
No, I understand.
You have a great time.
Yeah, next weekend.
- Morning.
- Hey there.
- What's wrong? - It's Alex's birthday tomorrow.
- Yeah, I heard.
- I wanted to throw him a party.
But Austin's his only friend and his folks are taking him skiing.
- Get him a clown.
- Yeah.
Good idea.
What's wrong with a clown? Kids love clowns.
Next time inject five cc's of fluorescein and observe under a Wood's lamp.
I wasn't sure.
Then come find me, don't just wait.
I didn't want to interrupt the meeting.
Neela, we were ranking fourth-year med students in there.
And everybody agreed you're really bright and we like- - Someone spoke poorly of me? - Nobody particular.
- Dr.
Chen? She's had it in for me- - Neela.
You have to be more decisive.
Okay, you have to be more proactive.
They feel I'm too passive? Tell you what, next four hours, you're a doctor.
Carry a minimum of three patients at all times.
Rescue 37, county base, go ahead.
Start workups, order their labs and meds and present back to me only after you put your own plan into action.
- Today, you're a shark.
- Shark? - Keep swimming or die.
- County General, over.
Car versus nursing home medivan.
Getting the driver, two passengers.
Anybody unstable? - Good vitals on all.
ETA, nine minutes.
- Got the first one.
Okay.
So work up these three.
In fact, just work up these two.
That's enough.
And then go help Gallant.
Hey, Mike.
Leaving that stripper in Curtain 4 with the broken toe for you.
- Try not to T.
U.
B.
E.
her.
- What are you talking about? Totally Unnecessary Breast Exam.
Avoid your worst impulses.
- I think you're projecting.
- Michael, hi.
New-onset seizure.
Needs to go to Medicine.
Post-op appy with fever needs a belly CT.
Call me if there's a problem.
- Got you.
- Feel like getting breakfast? Maybe another time.
Deb, lady waiting for you in Triage.
- Gallant can take her.
- It's not a patient.
She's a nurse.
She says she works for you.
Have a good shift, Neela.
Lucia? - Sorry to bother you.
- Something happen with my dad? No.
The night nurse agreed to stay late.
I'm not coming back.
Your father won't wear the diaper.
He throws food at me.
When I try to help dress him, he yells very bad words.
I appreciate your patience.
You know, this isn't really him.
I know he's a very good man, Dr.
Chen, but I can't do it anymore.
If you could just give me a few days until I can get a replacement- Here's my address.
You can send my last check there.
- And give him this for me.
- Lucia I pray for him.
I don't like working on old people or children or drunks.
And what's with all the sick people? They make it such a drag.
He's just motivating you for the match rankings.
You know, maybe they're right.
Maybe this job's just too fast for me.
Too unpredictable.
It's a big hospital.
If ER's not a good fit- Then what? NICU made me wanna jump off the roof.
Pedes is full of screaming brats and parents and ob-gyn's a lifetime of overnights and malpractice suits.
I could go into research or teaching, but is that really why I became a doctor? I'm sorry.
Were you talking to me? This place is so up and down.
I mean, you learn to ride through the rough days.
I did.
- You were probably good from the start.
- Are you kidding me? I came in young, dumb and scared.
At least you You're good with the books.
You really like it here? I wouldn't stay if I didn't.
Luis Sanchez, MVA passenger deformed upper right leg, probable femur fracture.
- No! - Give anything for the pain? - Pressure's too low, 90/70.
- From a nursing home? - Make it stop! It hurts! - Is this a change in mental status? I don't think it's from the crash.
Home said he fell in December.
Can you call my wife? I have a wife.
Figured he had some kind of brain injury.
Lower-extremity fracture, borderline pressure.
Need to rule out intra-abdominal bleed.
Trauma 1.
- Two more MVA's rolling in behind me.
- Okay.
On my way.
- Can we medicate? - Once his pressure's up.
- Here's the SonoSite.
- Two liters of saline wide open.
Maybe we can draw up analgesics? - Luis, do you have any allergies? - I don't know, I don't know.
Are you taking any medications? - Mary gives me my pills.
- What kind of pills? Blue and green and three white.
Morrison's good.
No blood in the belly.
- Pressure's up to 100.
- Morphine? Need a med list and allergy history first.
Make it stop! It hurts! Pocket doppler and Surgilube.
- I don't like - Cole's potassium is 3.
2.
- Forty of K-Dur.
- Suze, I'm not gonna do it.
- Then he'll press charges.
- I have other things.
- We should press charges.
- This is Neela from County.
For having a disturbing pickup line? I need to speak to a nurse.
- I believe the name's Mary.
- Just say you're sorry.
Valproic acid level for Mr.
Bernstein.
Done with your freak.
Give a half bolus, seven per kilo IV.
When will the nurse be available? Can you read me the list from the chart then? - Why not? - Can Mrs.
Herrero eat? Two-gram sodium diet, Sorry you had a bad morning, but Luis Sanchez had a worse one.
So could you please fax us the med list as soon as possible? Screw you! You want it, get your ass How about a magician? Magicians are cool.
Last year he wanted a pig embryo.
You really think a magician's gonna do it? Lucy Kilmer, another van passenger from the nursing home.
History of laryngeal cancer, complains of low back pain.
- Where was she sitting? - Middle row.
- Vitals good, resps 12.
- Any belly pain, ma'am? No, I'm okay.
- Carter needs help with the van driver.
- I have just the thing for him.
Paintball.
Good idea.
Put a gun in his hand.
- Fifty more of fent is in.
- Got a flail segment with hemopneumo.
Betadine and size-eight sterile gloves.
- What do you need? - Tachy at 126.
The guy next door needs meds but there's no drug records.
- Call the nursing home.
- I did.
They'll get back to me.
- You tell them it was urgent? - They seem very disorganized.
I'll need a second Thora-Seal.
You keep paperwork on the patients you drive? He's not breathing.
In-line traction.
Get ready to bag him.
I need a doctor.
Trouble with a trach.
- Carter.
- Neela, go with Sam.
- BP holding at 126 systolic.
- Okay, bag him up.
- Trach's out.
- She must have pulled it.
She needs a new one.
Number-four shiley, uncuffed.
- Okay, I'll call a doctor.
- No, no.
I can do it.
- You need some Surgilube.
- Right.
Okay, ma'am, extend your neck and look up at the ceiling.
On your third breath.
Ready? In, out, in, out.
Big breath in.
- Pulse ox coming up.
- Let's tie it in.
Got it.
Thank you.
Doctors? We don't need no stinking doctors.
- Neela! - She could use some ice chips.
Sats are coming up.
Transport information on the passengers.
Found it in his jacket.
- Go! Go! - Into the pleural space, chest tube's in.
Up to 120.
Discharge summary from the last hospital visit.
- When was it? - Three weeks ago.
Good.
Good enough.
Mr.
Anderson's vomiting blood in CT.
Okay.
Titrate morphine to pain.
Start with four milligrams.
Hemocue's 15.
I don't think he has any internal bleeding.
Stop.
Not the morphine.
Nausea and vomiting with morphine during his last hospitalization.
What do you wanna do? I'll be right back.
- Jerry, tell him.
- It is not unmanly to apologize.
Just do it and let's get out of here.
I'm exhausted.
Okay.
I'm going in.
- Dr.
Gallant go to CT yet? - Yeah, he's there.
Has there been a fax for me? Price list from Crazy Joe's Party Supplies? Who knew piñatas were so expensive? - Damn it.
- Everything okay, Neela? Got it taken care of.
Neela, Mr.
Lavecchia's urine's four-plus for blood.
- Kidney stone, 30 of toradol.
- I pulled Demerol.
No.
Give the Toradol 15 minutes before we try narcotics.
- All right.
I'll put it away.
- No, I'll take it.
Pain scale, eight out of ten.
Give him something.
Discharge summary says he got post-op Demerol.
Good.
How much? Abby, triple-lumen CVP kit? - Go ahead.
I'll take care of it.
- Please.
- Please stop hurting.
Please.
- All right, Luis.
This is going to make you feel much better.
It's so sweet to see them growing.
- Babies? - Men.
Dr.
Lewis, Mr.
Hemorrhoid in 3 is asking for you.
Oh, no.
I'm not here.
I left an hour ago.
- Crazy bastard! Get off me! - Pull his hair! Chuck, stop! Oh, my God.
Stop it, Chuck.
- Get your hands off me! - Come on.
Come on, guys.
- Come on, Chuck.
- Okay.
All right, all right.
It don't hurt no more.
You made it go away.
Isolated femur fracture awaiting Ortho.
No evidence of occult blood loss, vitals stable, medicated for pain.
Good.
Wheezing in Two, sudden-onset visual loss in the eye room.
- Which one should I take? - Both.
Keep it up.
- I never touched the guy.
- Says you handled him aggressively.
- She handled him? - Yeah, in his dreams.
- There are potential lawsuits here.
- You're kidding me.
He's threatened to sue the hospital, Emergency Department city, county and fire department.
- I'm not even on duty.
- I need this to go away.
Either I get the lawyers down here and- No, fine, I will talk to him.
- What? No.
No.
- No, he's weird, he's not nuts.
I will talk some sense into him.
Hernia's trapped outside the abdomen.
That bad? - You ready to round? - Deep breath, Bobby.
- Better? - Yeah, thanks.
A surgeon will come.
Straightforward procedure, nothing to worry about.
- Cool.
- Inguinal hernia? Incarcerated.
Reduced without sedation.
The kid's tough.
Twenty-year-old asthmatic came in with a sat of 89.
On his third albuterol with atrovent, received sixty of pred.
Aeration's improved but still 92 on room air.
- Call Medicine? - On their way.
Can I get some more water? Tiger Lily Lee, 24, cotton mouth.
- I'm, like, parched all the time.
- History of polydipsia led me to check her blood sugar, 642.
New-onset diabetes.
Not DKA yet.
- You should give 10 units- - Of regular insulin two liters of saline, and I consulted Endocrine.
Back to bed.
Great.
You can send it to this address.
- Hey.
- Oh, Neela.
We're on our way out.
- She's looking much better.
- Yeah.
Back to her usual self.
Viral gastroenteritis.
I consulted Kovac as you were too busy.
Thanks for your help, doctor.
Mr.
Silvio, four ounces every hour.
And don't let her chug, because she'll just throw it back up.
Rehydration, avoided IV, out in an hour.
The girl is on fire.
- Yeah, you told us so.
- I told you so.
- Told you what? - Nothing.
Attending gossip.
- Hey, did you check out the van driver? - Yes.
He needs an exploratory laparotomy.
We're moving him up.
So? His lungs re-expanded, No, no, no.
Not that.
Last night.
The surgeon.
Oh, it was splendid.
Is that British for sweaty and hot? - I don't kiss and tell.
- Abby.
Radiology's bouncing back your patient.
His temp's up and he's unresponsive.
- I'm gonna need some dirt later.
- Our gift shop sucks.
Couldn't find anything? Novelized version of The Matrix Reloaded.
I had them fax over a menu so you could see.
Mr.
Hyde's Tavern.
It's a haunted-mansion restaurant.
Strawberry blood shake? Tarantula fries? That's cool, right? I want it to be something he'll remember.
Special.
What? A blood shake's not special? This is Frederika Torrez.
Hurt her ankle during tennis team practice.
- Who put this on? - Sister Margaret.
She's my coach.
- Did she come with you? - She's out in the waiting room.
Did you roll it inside or out? - I can't really remember.
- The toenail's bruised.
Did you do anything else besides twisting it? I don't think so.
Are you sure you didn't jam your toe or kick something? Okay.
There's this really creepy guy who keeps on flashing us during practice from outside the fence.
You know, opening his coat, and he's naked underneath.
I mean, totally.
- It's really gross.
- Yeah, I bet.
Sister Margaret called the cops but he got away before they showed up.
So today we just got sick of it.
We all ran after him and got some whacks in before he got away.
You beat this man up? Sister Margaret also teaches us self defense.
She's cool.
How bad did you hurt him? I'm pretty sure we kicked his ass.
Need a little help here.
He's unresponsive.
Temp's 105.
8.
- He didn't have a fever before.
Luis? - He needs a septic workup.
CBC, blood cultures times two, cathed UA, spinal tap? - Rule out encephalitis and meningitis.
- Oh, no! - All right, roll him.
- Ativan? - Four mgs.
- Push it.
Is he on phenothiazine? - What does the medical record say? - I'll see if it came in.
You didn't get it yet? - Headache's worse.
- I'll get you another shot.
- Did you look at my x-rays yet? - Soon, Mrs.
Jenkins.
- Slow down, you're showing us up.
- Luis is seizing.
- Who? - Brain injury guy.
- I thought he was stable.
- Not anymore.
- Six of Ativan on board.
- Another gram of Dilantin.
- Med list.
- Why didn't you have it? Fax wasn't in.
Driver's record was only three weeks old.
All right, read it to me.
Baclofen, omeprazole, Keflex, tolderodine.
The only thing new is his anti-depressant.
Phenelzine? - Monoamine oxidase inhibitor.
- What did you give him? - Morphine.
- Need to think about an airway.
- No, Demerol.
- You gave Demerol? - He had nausea with morphine- - Serotonin syndrome.
- What? - Never give Demerol with an inhibitor.
- It can be fatal.
- Let's get him on O2, 15 liters.
Okay, spinal tap.
Come on, prep a drape.
Your better half got that idiot to drop the whole thing.
She did? What do we have to do? You don't have to do anything.
- You mind if I lift your shirt up a bit? - Don't push your luck, creep.
You are dead.
Don't worry.
I'll get Chuny to put battery acid in his IV.
Hey, Jerry, will you check on my x-rays? What's up with you? I defended Susan from some freak.
And ended up getting her molested.
I can't watch this anymore.
George Deakins, mugged under the Michigan Avenue Bridge.
Lovely day.
You'd think you could take a walk by the river.
- Could you remove your coat, please? - I'd rather not.
In order to examine you, I need to listen to your chest.
It's all right, George.
They steal your clothes? Yeah.
Okay, get him a drape.
Cocktail napkin ought to do it.
So they scratched you up pretty good.
How many guys were there? Must have been, like, four or five.
With long nails and a tennis racket? So, George you're a sports fan? - Fluid looks clear.
- BP's sky high, 220/140.
Start an esmolol drip.
- Hypertension part of the syndrome? - Who pushed Demerol for you? - Nobody.
I did.
- There was no nurse? - I was called out.
- It's not Abby's fault.
I'm capable of pushing pain meds.
Shouldn't push without a history.
- I didn't wanna wait.
He was in pain.
- Who did you speak to? - The receptionist.
- So you didn't actually talk to a doctor- - Dr.
Carter- - I couldn't.
No.
You can't take no for an answer when you have an unstable patient.
I gave her the order.
I thought you said morphine.
Neela saw it was contra-indicated, so I changed it.
And what? You forgot? I was a bit preoccupied.
Had someone crashing in CT.
- Dr.
Gallant- - Myoclonus and hyper-reflexia here.
Isn't there a serotonin antagonist we can give him? - We just have to wait.
- For what? To see if he lives.
When can I go? Talk to the police first.
The police? About my mugging? Yeah.
- Still haven't left? - I don't wanna talk about it.
I am going to kill you.
Baby, please, I am sorry.
Listen.
Come on.
Don't be like that.
Who knew that guy was such a whack? How does a guy get to be such a freak? - Born with a Y-chromosome? - Oh, so all men are twisted? - You said it.
- You hate men? If it weren't for sperm and heavy lifting, you'd all be useless.
I can't wait to pop this baby out so men will quit looking at me like I'm Mother Teresa or the Maxim cover.
It's not just men.
The world is full of degenerates.
Yeah.
And the sad part is they always get away with it.
Get him! Get him! Get him! Temp's still up, 104.
Another 200 of IV dantrolene.
How come there's no written order? - We were busy.
I called it out on the run.
- Demerol, 50 milligrams IV push.
Verbal order at 10: 23.
Dr.
Gallant, can I speak with you for a moment? - You're right.
It was more like 10:45.
- Pulse ox down to 82.
- He's not moving any air.
- Too much Ativan? Or neurologic damage from hyperthermia.
Let's open an intubation tray bag him on 100 percent.
- His wife and daughter are here.
- Suction's ready.
Call Respiratory for a vent.
- Sats are up to 89 with bagging.
- Take them to the family room.
Neela, you're doing the tube.
Let's go.
Welcome to the perv ward, Mr.
Deakins.
- You put me in a special room? - Don't worry.
They're all special.
Pervert's a relative term, honey.
Call me honey again, I give you the longest Foley catheter in the world.
Neosporin to the lac.
BID.
So I've got our problem solved.
- Alex's birthday party.
- Thanks for the help, Luka.
But I think it's my problem.
You see, that's your first mistake.
Anyway, a plan is in motion, arrangements are being made and everything is under control.
Keegan's CBC isn't back yet and I need a head CT on Hong.
Do me a favor? Check my departure time? - What, are you flying through Paris? - Amsterdam.
Hello! - Frank.
- Hey, Frank.
- What's up? How are you? - Thought I'd stop on my way from rehab.
- How's that going? - How do you think? They split me open like a Montana trout.
You don't just bounce back, you know? - Wanna see my scar? - No.
Guy in Two might wanna touch it.
- You look good.
You do.
- I can do two miles on the treadmill.
I haven't been able to do that since, well, ever.
- Where are my last two paychecks? - Been holding them for you.
- Where? In your wallet? - When are you coming back? I don't know.
Rehab's like a vacation, my old police benefits are a charm I don't really miss this sideshow.
- Is Dr.
Pratt around? - He's off today.
- Tell him I owe him a beer.
- Sure thing.
My doctor's not ready for me to come back to work yet.
It's gonna be a while.
But I do miss everybody.
I just wanted to say that.
Four-year-old, left upper quadrant pain.
Found with shortness of breath, confusion.
He kept asking for me even though I was standing right there.
- Tachy at 144, resps 42.
- BP, 86/55.
- When did your tummy start hurting? - No, Mommy, no.
She's on her way, buddy.
He's not making any sense.
- Any medical problems? - No.
Always been healthy.
Seventy-seven systolic.
- How are you doing, Tevin? - I don't like horses.
He's altered.
Have an intubation tray ready and squeeze in those fluids.
- Do you know what this is? - Your son's spleen is enlarged.
It may be acting like a sponge, soaking up his blood so it can't circulate.
So, what can you do to stop it? Hopefully transfusions will keep him stable until we know the cause.
First liter in.
Pulse in the 70s.
Okay, keep the NS coming.
Femoral-line kit.
I'm with him every day.
I take care of him.
Nothing like this has ever happened.
Does your son have a history of thalassemia or sickle cell disease? My wife has the trait, I tested negative.
I wanna go on a Ferris wheel.
As soon as you're better, buddy.
I don't know what that other thing is.
Thalassemia.
It's a hereditary anemia.
Here you go.
Talking to him's the best thing you can do.
Blood's here.
Line's in.
Run them on the infuser.
Occult trauma? Should we call in social work? I don't know.
Could be malignancy, hemoglobinopathies- - That's some differential.
- Yeah.
Add a sickle screen and HIV to the labs.
We didn't realize Luis was recently put on phenelzine.
An interaction between the drugs creates the condition serotonin syndrome.
You get very sick.
Like when they gave him the morphine? Worse.
You get high fever, high blood pressure, rapid heart rate, muscle spasms.
- How long does that last? - A few days at least.
But it's very serious.
Up to 30 percent of the people with serotonin syndrome die from it.
- So 70 percent survive? - Yes, ma'am.
They didn't think he'd ever wake up after the fall, but he did.
Good.
Good.
That means he's a fighter.
He's really smart, you know? I mean, he was gonna go back to school before the accident.
Then I got pregnant again.
My dad hired him on at his roofing business.
Don't usually work when it's icy.
But there was a job that he wanted to finish before Christmas.
- Why say you did this? - It doesn't change anything.
- I'm partially to blame.
- It's okay to lie? - Do you want to match or not? - Only if I deserve to.
You do.
So let this be my fault.
Patellar dislocation in Curtain 4 needs a reduction.
- How's Luis? - He's stable.
It's looking pretty good.
- Is there something I should know about? - No.
You did what you were told.
Gallant's supervising resident.
Should have known not to order up a drug without a medical history.
He didn't.
I did.
You ordered the Demerol? I assessed it, I ordered it, I pushed it.
And you didn't run it by an Attending or a Resident? - No.
- Because I asked you to be autonomous? Found an Arabic interpreter for your belly-pain lady.
Thank you.
All right, we need to talk about this, the three of us.
- Everything okay? - Fantastic.
Oh, Lavecchia's results.
Kidney stone from this morning.
No hydro, pain-free with Toradol and ready to go home just like you said.
Didn't need the Demerol after all.
Still have the vial? - I'll put it back in lockup.
- I used it for a patient.
Sam, did you get labs back on Tevin? - How's Tevin doing? - He's doing much better.
- I wanna go home.
- Mr.
Walker.
Hey, wanna pick out a sticker? Tevin tested positive for sickle cell anemia.
That's impossible.
I told you I don't carry the gene.
Maybe there was a mistake with your test.
Maybe there was a mistake with your test.
What your son has, splenic sequestration, is consistent with sickle cell.
A form that's very manageable.
You're not listening.
I told you I went to a genetic counselor.
He said I'm not a carrier that our son could not get the disease unless both parents are.
That's true.
So what? You're saying I'm not his father? What I'd like to do is send his blood for a more advanced test.
Just to be sure.
Send my blood too.
Test me again.
Neela.
Carter wants to talk to me after my shift.
- I told him what happened.
- You what? I didn't think it was right for us to lie about it.
Nobody needed to know.
That was the point.
Please, someone! Please help! Something's wrong! He went into V-tach.
Unsuccessful cardioversion at 200.
- Get him off the vent, bag him! - Please.
He can't die.
Charge to 300.
Clear.
No change.
Try 360.
- Need any help? - Amp of epi after the next one.
- Charged.
- Clear.
- V-fib, 100 of lidocaine.
- This is not supposed to happen.
Go and find Dr.
Carter now.
- Let's go, 360 again.
- Clear.
Come on, hit him again, 360.
Clear.
- Still in fib.
- Three sixty again.
Clear.
Asystole.
- How long has it been? - Shall we try the high-dose epi? Forty-two minutes.
Run the dopamine.
We still have time.
- Or we can pace him.
- Neela.
- Let's try pacing him.
- Tie off the lines leave the ET for the coroner.
Carter, inform the family and then meet us.
Are his tests back? They confirmed my diagnosis.
The good thing is most kids do very well with folate and prophylactic antibiotics.
Good.
That's good.
I also ran your blood through.
- The tests indicate that- - Is there anything affecting my health that I need to know about? Not really.
No.
All that piece of paper is gonna tell me is whether or not he's got my genes.
Either way, he's still my son.
I'm his father.
From a medical standpoint, it's a bit more complicated.
Liza My wife and I, we We went through a rough patch about five years ago.
We broke up for a few weeks.
She got pregnant right after we got back together.
We've been happy ever since.
She's gonna want to know about Tevin's condition.
I'll tell her that I'm a carrier.
He got it from both of us.
And he's gonna be okay.
He's in here, Mrs.
Walker.
- Honey, is he all right? - He's fine.
He's fine.
Did you get his labs back? - Is he the father? - Yeah.
Hey, I didn't mean to keep ragging on your suggestions before.
Maybe Mr.
Jekyll's isn't a bad idea.
Mr.
Hyde's.
Look, I know I'm not exactly Carol Brady.
So I really wanted it to be special.
It will be.
Be ready to go in a half-hour.
I have to pick something up, okay? Was the med list current? I think we should stick to protocol.
As the Attending, I'd like to review this with my staff before we do this.
Was the med list current or not? It was recent.
It wasn't completely up to date.
And no one checked with the nursing home? - I tried.
- You tried? - Abby, why didn't you push the meds? - I was called out.
But the result wouldn't have been any different.
As the nurse, it's your responsibility to double-check allergies and interactions.
I thought that had been done to the- It's a case of managing a patient's pain with incomplete information.
I suspect a jury won't see it that way.
- Who made the decision? - I did.
You did? So now we let medical students push pain meds without supervision? - That's not what happened.
- I was with a patient.
Neela did exactly what I told her.
Actually, that's not- You need a few minutes to get your story straight? What does it say in the chart? Exactly what I've been saying.
I ordered the drug, and Neela pushed it.
And is that accurate? Like I said, I wasn't in the room.
- Simple question.
Is it accurate? - As far as I know yes.
A young man comes in here and dies of a lethal drug reaction that could have been prevented with one phone call.
Next time why don't we just send a blank check to the family's attorney? Mom! Mom! - Son of Sam is back.
- Mom! - What are you doing here? - Luka picked me up.
It's amazing! - We gotta go, though! - Hold on.
I'll take those.
If we hurry, we can get there by 11.
What are you talking about? What are you wearing? Luka said I have to wear a life vest for the boat.
Boat? What boat? Isn't it awesome? It's bigger than our whole apartment.
Wow.
You really went a whole other direction.
A weekend in the great outdoors.
Fishing, camping, burning s' mores.
-S' mores.
Do you know what that is? -White thing on a stick.
Come on, you gotta see inside.
- Wait.
Where are we going? - I rented a spot at Lake Geneva.
Bottom of the ninth, two outs, nobody on and here comes Kovac with a clutch home run.
Is that baseball? How you gonna back this thing out? Mr.
Joss's triple-A repair went well.
He's stable in the ICU.
And Dr.
Edson's finishing up on the perirectal abscess right now.
And do you know a good cheap red wine that goes with spicy food? I have a date.
Two nights in a row.
It's with the teacher tonight.
Okay.
Zinfandel.
I'm not completely comfortable with waking up with one man and going out with another the next night.
Well, if we were guys, we'd be talking about carburetors right now.
So you don't think it's slutty? No.
I just won't sleep with him.
That sounds like a good plan.
- Good night.
- Good night.
Women plan, God laughs.
Hey, when did I become the guru of sluttiness? - Did you start that banana bag on Vern? - Three times.
He keeps going off to the bathroom and coming back drunk.
I think I should delete emergency medicine from my match list.
- One mistake.
I pushed you too hard.
- No.
What they said about me in your meeting was all true.
Look, you're a talented doctor.
And you did a lot of good things today.
Nothing I did on this shift can convince me or anyone else that I belong here.
Yesterday you were a little too cautious.
Today you were a little too reckless.
Somewhere in the middle is the way to practice emergency medicine.
I just want you to know I shouldn't have left you alone with the patient until he was stable.
It's my fault.
What you did was the sweetest, dumbest thing anyone has done for me.
Well, something like this could have derailed your career.
Worst that'll happen to me is discipline, counseling.
I'll be all right.
You don't look all right.
Seems kind of silly now, but out in the bay this morning, I was I was thinking about asking you out.
I was thinking of saying yes.
I have that cefoxitin for Mr.
Martin.
I just need the extension tubing.
- Are you okay? - I'm fine.
I'll take care of it.
- Let me help you find it.
- I said I can do it! Bottom drawer.
Well I suppose it's time to call it a night.
- You're welcome to stay a little longer.
- No, no, no.
I really should get going.
I'll get my coat.
I'll help you find it.
It was such a lovely evening.
And I am so glad that the girls like each other.
Ella's a great kid.
Oh, and it was really good of you to pick her up from school.
Thank you so much.
You want me to carry her to the car for you? No, no.
No, I'm fine.
I can manage.
So good night.
You should have come and talked to me.
You know why I backed you up in there? Because if Weaver knew the truth you'd be done.
I know you went out on a limb for me but I could just say I got confused.
You could have.
Until you falsified the chart.
- But - That's a felony.
Okay.
- Then I gotta go tear it up.
- Too late.
Why? Why? It's just one entry on an otherwise blank order sheet, okay? Nobody's gonna know it's missing.
We can talk to Weaver again.
It's too late! It's already up in Legal.
You know, you guys sit up there and you decide who's gonna go and who's gonna stay.
I mean, why did you have to push her? Why'd you have to push her?! The only reason she screwed up is you made her think she wasn't good enough! She wasn't cutting it! We're talking about you now, Michael.
I wasn't thinking.
I'm sorry.
Yeah.
Me too.