ER s11e06 Episode Script
Time of Death
E.
R.
E.
R.
11x06 "TIME OF DEATH" PATIENTS MAY NOT BE SEEN IN ORDER OF THEIR ARRIVAL Who do I gotta screw to get some health care around here? Well, honey? Try an intern.
They're always hard up.
- Come on, Jeremy.
I'll take you back.
- Where? To see the doctor.
- My dad here yet? - No.
He's on his way.
Did I give my ticket to you? Just a little longer, sir.
Don't make me late.
My baggage went through.
Right.
Come on, Jeremy.
Eleven-year-old boy with multiple lacs.
Hey, how you doing, little man? TV fell on him.
Kids were home alone.
Okay.
We'll get to him real soon.
- Standard of care is primary- - Standard of care is for rookies.
Get him started, Jane.
Dr.
Pratt will be right there.
And I got a real winner for you: Belly pain with combustible breath.
- That creepy homeless guy? - I don't think he's homeless.
How about we wait till he sobers up? I'll be home in bed by then.
- He needs to be examined, Pratt.
- I'll take care of it.
- How long has he been here? - Oh, about two hours.
He thinks he's in an airport.
- He's altered? - Yeah, a little.
You ask me, we need one line for legitimate patients - another for the rest.
- Good thing nobody asked.
UTl, dislocated shoulder, and rapid hair loss all need to be signed out.
I haven't been this starved since the last Burning Man festival.
- Who wants some 'za? - You just had a burger.
- Fast metabolism.
- Pratt.
Wheezing guy was driving insomnia lady crazy.
- So I moved him into Exam 3.
- Okay, beautiful.
Okay.
Who's the lucky bastard that gets to take my blood? - I need CBC, LFTs and amylase.
- I'll do it.
- Is this about your needle stick? - Yeah.
Well, you gotta do what you gotta do, right? This is Dr.
Barnett from County.
I'll take six- No, make that seven.
Two pepperoni, two sausage and pepper, two Hawaiian and one with the works.
It's, let's see, 11:23 right now, so we'll get that at 12:03, right? All right, man.
Cool.
Seven pies? What was that about? Guaranteed delivery within 40 minutes or there's no charge.
What the guy doesn't know is Wacker's closed and The Loop is a parking lot.
There is such a thing as a free lunch.
Luka, belly-pain guy's going down.
Somebody bring a gurney.
Sir? Open your eyes, sir.
Hey, doctor.
No way.
I was here before him.
Vitals were normal when I triaged him.
That nurse told me I was next! Diaphoretic.
Carotid's weak and thready.
- Seventy systolic.
- Is that what it takes? Flopping around on the floor like I'm dying? Yeah, don't push me! Watch me! - Hey! Watch! Okay, here we go! - Get him on O2 right away.
Hey! Look at me! - Look! See me? - My bag.
- My bag.
I want my bag.
- I got it! Start the EKG in case he's having an Ml.
What about me, huh? I might have an Ml too! Any history of hepatitis? Abby, can you give us a hand? - What about my blood draw? - I'll write you a note.
- What are you doing? - Get a 12-lead going.
- Where am I? - Sam, got the IV? - What are you doing? - Okay.
- Hey, Pratt, can you spare Jane? - Definitely.
Document everything we do and the time.
- Isn't that usually a nurse's job? - There's a nurses' shortage.
- Haven't you heard? - What are you doing? Stop! - I may not know what to write.
- I'll tell you.
Start with two liters of O2 at 11:25.
Pulse ox, 98.
That's my bag.
Give me my bag back.
- I'll give you your bag back- - Get your hands off of me! - Calm down.
- Knock it off! Okay? We're here to help you.
We can try the nice way or we can try other options.
- This is how you help? - Yeah, that's right, sir.
JVD is 10 centimeters.
The EEG is printing.
- Chart it.
- Eleven twenty-six.
- Got your line.
What do you want sent? - Abby? CBC, Chem-20, PT/PTT, troponin, type and hold.
And add a serum ammonia.
EKG looks good.
There's no ischemic changes.
Excuse me.
Excuse me.
Hey.
Hey! Hey.
My name is Charlie Metcalf, okay? - Okay? - Okay.
- Okay? - Okay.
- Don't! - Okay, I'm not gonna hurt you, okay? - Dr.
Kovac.
- Okay, let's get him gowned.
We need you to work with us, Mr.
Metcalf.
This will be much easier.
- What's the trouble? - Possible extensive tendon lac.
Okay.
Can you move your toes up and down? - How did that happen? - My sister pulled the television down.
It was an accident.
I guess it's true then, huh? TV really is bad for kids.
- Where were your parents? - My dad was at work.
- Babysitter? - We can't afford one.
I watch after Steffie.
Can't afford a babysitter but they got a TV.
- Luka? - Somebody call the dad? The neighbor who brought him in.
Get him cleaned up and send for x-rays.
We have three TVs.
- That IV making you feel better? - Yeah.
Yeah, look.
Before- I'm sorry.
I just was getting a little- Eleven twenty-seven, 300 cc bolus is in.
Pulse down to 110.
No murmur, rubs or gallops.
Multiple spider angiomas on the chest wall.
Watch my stomach.
Watch- - Have you seen a doctor lately? - It's been a couple of years.
- Do you have a primary-care physician? - No.
Not at the present time.
- I need a 5-0 nylon.
- Over there.
Who were you seeing a couple of years ago? I don't remember the guy's name.
Some doctor in Taylorville.
Taylorville? - You live there? - Yeah.
- There's a prison there, right? - Yeah.
It's a correctional facility.
What's the big deal? - I knew somebody who spent time there.
- Yeah, small world.
Positive fluid wave.
Liver is small.
- Ascites? - Yeah.
What's that? It means you have fluid in your belly.
- So, what were you in for? - A mistake.
What you mean? You weren't framed? Spleen's enlarged.
- Chart a BP, 100/70 at 11:28.
- Caput medusae.
What kind of mistake? I killed a guy.
Palmar erythema and muscle atrophy.
- Oh, yeah? For what? - For asking too many damn questions.
- HemoCue is 7.
2.
- Yeah.
- My dad here yet? - No, not yet.
- Hey, kid.
- Don't look at him.
Just look this way.
- Hey, pally.
- Don't worry about him.
- Mr.
Metcalf.
- What? Mr.
Metcalf, you're very anemic and you could be losing blood from an ulcer.
- You a drinker? - Yeah.
- Drinking in jail? - Yeah.
Not gonna rat me to my parole board? Important we know what you've been taking.
Pruno.
Breakfast of felons.
Now I drink wine, beer, I don't know, anything I can get my hands on.
- Pruno? - Yeah.
It's fruit- Fruit and bread from the cafeteria.
You put it in a garbage bag with toilet water and then you let it ferment.
- Ferment where? - Under the bed.
You strain it through your socks and then you're ready to go.
If you're desperate, it tastes like a martini.
Oh, yeah? Yeah.
You don't know what it's like to need a drink.
- I can imagine.
- Yeah.
To check for blood loss, we're gonna have to do a rectal exam.
A what? No, no, no.
I spent the last nine years avoiding rectals.
No.
- It's the only way for me to know- - You gonna stick your finger up my ass? - My gloved and lubricated finger, yeah.
- No.
No.
It's smaller than your bowel movements.
Listen, boss.
Exit only, you understand? Exit only.
If you're bleeding internally, it could be life-threatening.
Okay, fine.
Can I-? Maybe we can cover me up or something? - I don't want it! - Hey, man, would I hurt you? No! I don't want it! I'm not gonna hurt you, okay? - I want my dad.
- Don't have to worry.
- Where's my dad? - Look at me.
I'm not gonna hurt you.
I want my dad! - I don't wanna get a shot.
- I'm not gonna hurt you, okay? Pally? - What's your name? - Jeremy.
Jeremy, you know, the way I see it, doctors are mean.
They wanna make us cry.
But you know what? If you don't, I won't.
What do you say? Let's show them.
Let's both not cry.
Okay, kid? Okay, Jeremy.
It's okay.
It's okay.
It's all right.
See? That's it.
Don't worry.
It's okay.
There it is.
Good job.
That's it.
See? Hey, that wasn't bad, was it? We have to put a tube down your nose into your stomach to figure out what's causing the bleeding.
No, the docs in the joint gave me one of those for my pancreatitis.
We're gonna numb it up so it won't be so bad.
We won't keep the tube in any longer than necessary, okay? Sit him up.
- You know I used to be an artist? - Open.
Pressure's up to 110/76.
- What kind of artist? - I did some painting.
A mural for my wife's church.
You know, mostly I earned my living as a contractor a carpenter, that sort of thing.
Fixing old places up.
Y'all could use my help around here.
If you swallow it while we pass it, it will go down easier.
All right, all right, all right.
Okay.
It's going down.
Keep swallowing.
It's going down.
That's good.
Very good.
All set.
Relax.
Okay.
Hook it up to low suction.
I was mixed up before.
I get confused in my head.
But I'm better now.
Like you think you're going on a trip? In the waiting room, you kept asking me what time your flight was.
Sometimes it's a train or a bus.
Sometimes it's a boat.
One time I was getting ready to parachute.
- Is that what the suitcase is all about? - No, I always have that.
You leave anything at the flop, it won't be there when you get back.
Those scumbags steal it.
NG output is one liter at 11:32.
Looks too dark for an ulcer.
- Varices? - What's that? That's when the elevated pressure in your liver backs up.
The veins of the esophagus become engorged and can bleed a lot.
Sometimes uncontrollably.
Emesis basin.
You made me worse.
- Get it out of me.
- No, no.
- That has to stay in.
- Get it out of me! Okay, soft restraints! - Get the tube out.
- Pressure's dropping, 82/66.
- Tachy at 130.
- Two units of type-specific.
- And call Gl down here now! - He needs a room.
No, no, no.
Don't, don't.
Trauma 1 is open.
Okay, Mr.
Metcalf, is there anyone we can call for you? - You mentioned you had a wife.
- No.
- Children? Siblings or anyone? - Nobody that will come.
Let's get him to X-ray.
You stay with him, okay? - I'll see you in an hour.
- Pratt, with us.
Make it four units, type-specific.
Take too long.
Get O-neg out of the cooler.
Get these off me.
Don't tie me down.
You can't keep tying me down! Let's go.
Prime the rapid infuser.
- Subclavian on the right? - Prep the chest.
- Let's go.
Prime the rapid infuser.
- Subclavian on the right? - Okay, prepping the chest.
- O-neg here.
Squeeze in the first unit.
Sam, second on the infuser.
- Pratt- - Push the octreotide.
- Been paying attention, huh? - Need me to do something? Yes.
Cycle the dynamap when it's ready.
A little Sandostatin's not gonna make his chances any better.
- It will diminish blood flow.
- But what's the point? - The odds of him making it are what? - Another 200 cc's out the NG tube.
He's that sick even though he was just lucid? He's on the edge.
All he needs is a push.
You know what? We got a lot of hands in here.
- You don't wanna help- - You're an Attending now? - No one wants to be a nurse anymore? - Pratt, come on.
- Prick.
- That's enough! - Heart rate's up to 140.
- Is he taking any meds? Check his bag.
He said all his stuff was in there.
- First unit's up.
- Eleven thirty-five.
- Pushing 50 mics of octreotide.
- All right.
Guide wire's passing.
Yo, hair of the dog.
- A hundred and fifty-one proof.
- This guy's a class act.
- Ready with your extension tubing.
- What's your problem? We're killing ourselves for a non-compliant, alcoholic - ex-con with end-stage liver failure.
- You wanna get out? Get out.
You know what? It's Friday.
I don't do lost causes on Friday.
It's a religious thing.
Second unit's going in.
Anything else in that bag we need to know about? No, but there's a picture.
It looks like him and his wife and a kid.
Here's a bunch of letters, a journal.
Pressure's 98/62 at 11:37.
And I don't know, some kind of painting.
- Where's my passport? - Where's your what? Give me my passport.
- I can't go without my shoes.
- Go where, Mr.
-? - Let me go.
Let me go.
- Okay.
- Head up to 20 degrees.
- Let me go.
- And check on Gl again.
- Let me go.
Thank you.
- I'll be right back.
- Get them off.
Get them off.
Do you have a problem with me? - No.
- It's him? - I was out of line.
- Okay.
Let's go.
The guy's a waste, dying from something that he's doing to himself.
Last time I checked, alcoholism was a disease.
So was suicide.
He should catch that and save us the trouble.
- We get ones like this every day.
- Then maybe I need a day off.
- It's personal? - I guess.
Good.
Then we don't have to talk about it.
- You like riding me? - I don't think I do.
No.
Ever since I was an intern, you've been on my back.
- Maybe a couple of times.
- Why? You're good, Pratt.
But I think you could be better.
There's a number you wrote with a name.
Bobby? Should we call him, Charlie? No.
No.
Don't call him, please.
I don't want anybody to call him.
- Okay.
- Okay? You understand? No calling.
- I don't want to see him.
- Gl's on their way.
Mr.
Metcalf, the veins at the end of your esophagus are bleeding a lot.
This is a result of your cirrhosis.
That also means you have less than a 50-percent chance of surviving.
Less than surviving for how long? A few months? "Months" months? What-? What? Not that long.
What we need to know is, if you stop breathing or your heart gives out do you want us to use heroic measures? Do heroic what? Do you want us to do CPR, shock your heart - or put you on a breathing machine? - Wait, wait, wait.
You're saying now? You're- You're saying now? You mean, like, today? No, no, no.
Look, no.
I have a lot of things that I have to do.
- Okay.
- I'm just not ready.
I'm not ready.
- I'm- - Okay.
Okay.
The man wants it all.
Okay.
I'm Adler from Gl.
How bad? About two and a half liters of output.
Pre-load the scope with a Saeed Six-Shooter.
What? What's a Six-Shooter? We're going to look down your esophagus and try to bend the veins to stop the bleeding.
- What's the deal with your suction? - Turn it up.
- I did.
- Nothing's coming out.
- Great.
- Check in 2, Abby.
Jane, get on the phone about a portable.
- You guys have suction in here? - Last time I checked.
- What time is it? - Eleven forty.
Why? They got 23 minutes or we eat for free.
- Hey, is your patient stable? - Smoke inhalation with wheezing.
- Okay.
We need the room.
- You into pepperoni, Abby? - You have ADD? Come on, let's go.
- Give us two minutes to finish.
- We need it now.
We're good here.
- The guy just needs to be tubed.
- This guy might need to be pronounced.
- Hope you're not a veggie - because I got meat on everything.
- See you later.
- Cetacaine and bite block.
- Little more numbing spray, Charlie? Okay, push two of Versed.
All right, Charlie.
Once we're ready to start you're gonna have to keep this between your teeth.
It stops you from biting the fiber-optic scope.
- Check the monitor.
- Is this Bobby? - Charlie? Is that your son? - Yeah.
Yeah.
- And your wife? - Evelyn.
Pretty.
You want me to call her? No.
No.
She's gone.
It's been a long time.
Well, what about Bobby? He must be all grown-up by now.
Yeah.
He's 19.
He's gonna be 20 next month.
He's in college.
Well, let's try to reach him, okay? I haven't talked to him since he was little.
His aunt gave me that number when I got out of prison, but I- Well, that's all the more reason to use it now.
Let's pull the NG.
Okay, Charlie.
Here we go.
- How's pressure? -108/58.
- Okay, ready to go.
- Hi.
I'm looking for Bobby Metcalf.
Okay.
Yeah.
You know what? Can you actually wake him up for me? Hi, Bobby? My name is Samantha Taggart.
I'm a nurse at the County General in Chicago.
- Grade-two varices? - Grade three.
Yeah.
We have your father here and Yeah.
And he's pretty sick.
Four columns, two hemorrhagic.
Two bands at each bleeding site, one at the others.
No- He's out.
Well, he's out of jail, yeah- - I don't know.
For a while, I think.
- Systolic's down to 90.
Is there any way you can come here and be with him? - Probably the Versed.
- Five-hundred cc saline bolus.
No.
You know what? He can't talk right now because he's in a procedure.
Sucking the varix into the cap.
Wait- Okay, hold on.
He wants to talk to you.
Sorry, that needs to stay in.
And firing.
Okay, let's talk.
Okay, guys.
I'm gonna put Mr.
Metcalf's son on the phone for a minute, okay? Bobby? - Dad? Is it you? - Yeah.
- It's me.
- So you're sick, huh? You dying? - No, no, no.
- Nurse, is he dying? He's very sick.
What am I supposed to say? Huh, Dad? It's been a long time.
So many things I- - Y eah.
- I don't know.
I- - Hey, Dad.
- Y eah? Nice knowing you.
I told you, you shouldn't call him.
Firing.
Good.
- Turn up my suction.
- Can you band it? - Not if I can't see it.
- Mr.
Metcalf? - BP 68/32.
- Mr.
Metcalf? - I can't even feel a pulse.
- Bobby.
Bobby.
- Bobby! - He's bleeding out.
Okay, turn him over.
Another two units on the infuser.
Ambu-bag.
Come on in.
The water's warm.
- Try the femoral.
- Get another four units up here.
FFP after these two.
Hey.
Hey, you dumb son of a bitch.
Hey, you dumb son of a bitch.
Thought we lost you there for a second.
- Bobby? - We had him on the phone.
Is he coming? No.
No, he's not coming, man.
BP's 86/42 at 11:44.
- Want the FFP? - Yeah.
And another unit of packed cells.
Dr.
Kovac.
How long have you been out of touch with him? Your son? A long time.
Since I went to prison.
Well, even in prison, he's still your kid.
Blood's here.
You don't know what it's like.
If I had a kid, I'd do everything I could to stay with him.
Need a Linton tube, a Kelly, and a 60-cc syringe.
You think you know, but you don't.
How it could all switch on you.
Life could turn on a dime.
Gets broke and you can't- You can't see a way to fix it.
Mr.
Metcalf, the specialist thinks we can't control the bleeding with the scope.
- So you want a Linton tube? - What? We pass a large balloon into your stomach.
So it helps us keep pressure on your veins.
All right.
What's there to lose? I'll test the balloon.
It was April 10th, 1992.
When Bobby was turning 8.
My wife asked me to go get some stuff for the party.
But I stayed so I could finish putting together this robot for him.
You know, so I made her go.
From the street I hear a thud.
This scream.
And I go to the window to look out.
And she's lying there like she's asleep on the street.
And ice-cream cake- Ice-cream cake was all around her on the pavement.
Five syringes.
So there I am.
There I am with this little boy to raise.
And what do I do? I start drinking.
I get high.
I can't keep it together.
I can't keep it together.
Then I stab some guy at a bar.
Just for- Just for nothing.
For nothing.
Because he looked at me wrong.
This one's good.
We can go up to 750 for hemostasis.
Okay.
Ready, Mr.
Metcalf? So where was your son after that? With my wife's folks.
Listen for bowel sounds.
At first they would bring him by on visiting days but after a while that stopped.
Then the letters started coming back unopened.
You know what? I don't feel good.
Something's wrong.
Something's wrong.
BUN, 74.
Creatinine, 8.
2.
Okay.
Call Renal and throw in a Foley.
Hey.
We should think about TIPS.
What's that? TIPS stands for Transjugular Intrahepatic Portosystemic Shunt.
It- We put a catheter from your neck to your belly.
By bridging the two vessels, we bypass the liver and slow down the bleeding.
- How much time would that give me? - It's hard to say.
- No urine output.
- Hepatorenal syndrome.
- Your kidneys are not working.
- He needs dialysis.
I'll make the call.
- Okay.
GSW to the belly.
- Not here, Chuny.
- There's nowhere else.
- Okay.
Move him over and keep traction on the Linton.
Hold on.
Okay, go ahead.
Okay, let's transfer him.
One, two, three.
No meds, no allergies, no past history.
NG, Foley, and a portable chest.
- Bastard shot me for stealing my spliff.
- I need another nurse.
Said it was his, but it was mine.
Rolled it this morning.
- What's going on? - They need to stabilize him.
I want my own damn room! Get the hell out of here, man.
- Screw you, jerk-off.
- Okay.
Doctors only talking now.
Damn, that's hard.
Even a gunshot in the belly don't buy a man some privacy.
Okay.
Two grams of cefoxitin, IV piggyback.
It's a house we rented one summer.
There's a lake there by it.
I took Bobby fishing there.
Periumbilical GSW with intestinal prolapse.
- All right.
What about the on-deck batter? - We're waiting for a TIPS and IR.
That sounds bad.
Let's get him up for an ex-lap.
Portable monitor.
Let's go.
- What about x-rays? - Get them upstairs.
T minus 11 minutes on those pizzas.
IR's already on the floor.
Renal's on the way.
Luka, he's getting tremulous.
I haven't had a drink since last night.
- It's alcohol withdrawal.
- Dr.
Pratt? - Yeah, that would be me.
- Hey.
Ramirez, Nephrology.
- Who's this guy? - We're gonna need central access.
- He's got a subclavian.
- That's great.
- Let's consent him and start the run.
- What? What is he talking about? He's here for the dialysis that we discussed.
I never discussed it.
You discussed it.
I never discussed it.
- Alfonso, how are you? - Is this a TIPS patient? Yeah.
And we should go first.
- What are you talking about? - That's what's gonna prolong his life.
Without the dialysis he'll bleed out the minute you spike his liver.
What? What-? Spike my liver? Will his pressure even tolerate dialysis if the varices bleed? - I don't understand.
What-? - I can support his pressure.
The Linton is supporting his pressure.
- What are you talking about? - Dr.
Kovac? Well, he's gonna need dialysis three times a week.
- Oh, yeah.
For the rest of his life.
- TIPS is not a cure.
- It's a bridge to a liver transplant.
- We know that's not gonna happen.
Hey, hey, hey.
I'm right here.
- Yeah.
- Talk to me.
Sorry.
Now, you can't fix my kidneys? You're gonna need dialysis three times a week.
And what about my liver problem and the bleeding? - The TIPS is a temporary measure.
- Your best hope is for a liver transplant.
I don't understand.
What are the odds of that? Based on your history of drinking, not good.
Is there any chance that I'm gonna be walking out of here? With the dialysis and the TIPS- I mean, today.
What are the chances that I'm gonna walk out of here today? None.
I don't want it.
I don't want anything, then.
If you don't have the TIPS procedure, we can't control the bleeding.
- You'll die.
- Yeah, I get it.
I get it.
Just stop everything.
- No blood transfusions? No breathing-? - No, it's over.
- No CPR? - No.
I need it to be very clear, Charlie.
If we don't continue with the treatment, do you understand what could happen? Yeah.
Yeah.
Okay.
Mr.
Metcalf is a DNR.
Eleven fifty-seven.
Wait.
Wait a minute.
Wait a minute.
Hey, hey, he's not competent.
Come on.
That's what he wants, Pratt.
Can you-? Can you do something for this? Hey, could we put him on an alcohol drip? - You're gonna get me drunk? - Just enough to stop tremors, Charlie.
Charlie, let us do the procedure.
You don't have to do this.
Call Try Bobby again.
Try my boy.
Get him on the phone.
If he knows it's really over, he'll come.
Okay? He'll come.
Hey, Bobby Metcalf? Oh, yeah.
It's the hospital calling again.
Yeah.
Do you think you could do that? Okay.
Thank you.
- What happened? - He went to class.
His roommate's gonna see if he can find him.
Can you take this out? It's uncomfortable.
- The tube's keeping you alive.
- It's uncomfortable.
Please.
Okay.
Is there-? Is there a window? Can you open a window and get some fresh air in here? Please? - Sam.
- Please.
All right.
Here we go.
- What is that? Lincoln Street? - Harrison.
I've worked here over a year.
Never thought about what was outside.
I worked here for six.
It's from the tube.
I'll take care of it.
Ten percent ethanol at 100 cc's an hour.
You know, your booze works fast.
Mad Dog IV, just for you.
All this stuff, you know it's just blinders.
It's just a screen.
I don't want anything separating me from what's happening.
I'm not gonna run and hide from this.
Pulse ox and dynamap can come off.
Last sats, 92.
My brother Lou died when we were kids.
My mom, she said She said, "Charlie, Lou's gone away on a long trip.
" Don't you just leave me here.
I wanna see a doctor now.
Last sats, 92.
When is my turn, huh? When is it going to be my turn, huh? People? When is it? When is my turn? Pulse, 104.
Resps, 18.
Temp, 98.
2.
Ninety-two.
One-oh-four.
One-seventy.
Ninety-one.
- What are you saying? - It's your vitals.
- Is it starting? - What, Charlie? Am I going? It's starting.
Don't you people have a system? Isn't there any method at all? Don't worry.
You won't be alone.
Good.
That's good.
Someone will stay with you.
Sam, you get this? Could you touch me? Sorry? My face? Please? Maybe we should anchor.
- What? - Do you think we should keep going? I don't know, Charlie.
Well, what about him? What do you think he wants? I don't know.
I don't think he knows.
Is it too late? Not if you don't want it to be, Charlie.
Watch it! Oh, no.
Oh, no.
Oh, no.
I feel drunk again.
- Yeah.
- Thank you.
Sure.
Okay, Mr.
Metcalf.
We're gonna keep a heart monitor on - and the alcohol drip for comfort.
- Okay.
I wanna take you off the octreotide now which is the last support measure.
Okay.
- Shouldn't be long now.
- Okay.
I never believed in God.
That might bite me in the ass now, huh? God will get over it.
Do you need this? - Can I take it? - Take it.
Take it.
What? - What can I take? - No, never mind.
Never mind.
What's it gonna be like there? Peaceful.
- Come back.
- Charlie.
Charlie.
Get all my stuff? Oh, yeah.
Yeah.
Make sure he gets it.
I will.
And give this to him.
You never knew your dad.
No.
That's too bad.
I don't let it bother me.
I bet it bothers him.
Bobby.
Let me in.
Open up.
Let me in.
Charlie, can you hear me? Charlie, can you hear me? Hey, pally.
You made it.
How do I look? You look okay.
I'm so sorry.
I'm so sorry.
Don't think about that.
Okay? Just take it easy.
It's okay, son.
It's Twelve-oh-four.
I'll take that.
Can someone just tell me that? How much longer? Ma'am, you need to wait in the room.
Let's go.
It's about time.
Been with the same patient for almost 45 minutes.
Whatever happened to "treat them and street them"? Do as I say, not as I do.
All right.
The TV kid's back from X-ray.
He's in Triage with his dad and his sister.
Things go south? He was a nice guy.
Just a drunk.
There's pizzas over here if you get hungry.
Got you one with anchovies.
Oh, and the delivery guy got here at 12:04.
You know what that means? It means he didn't make it on time.
Means lunch is on the house, my friend.
Hey, Jeremy, little man.
Back so soon? Hello, I'm Dr.
Pratt.
I'm the one who treated your son.
R.
E.
R.
11x06 "TIME OF DEATH" PATIENTS MAY NOT BE SEEN IN ORDER OF THEIR ARRIVAL Who do I gotta screw to get some health care around here? Well, honey? Try an intern.
They're always hard up.
- Come on, Jeremy.
I'll take you back.
- Where? To see the doctor.
- My dad here yet? - No.
He's on his way.
Did I give my ticket to you? Just a little longer, sir.
Don't make me late.
My baggage went through.
Right.
Come on, Jeremy.
Eleven-year-old boy with multiple lacs.
Hey, how you doing, little man? TV fell on him.
Kids were home alone.
Okay.
We'll get to him real soon.
- Standard of care is primary- - Standard of care is for rookies.
Get him started, Jane.
Dr.
Pratt will be right there.
And I got a real winner for you: Belly pain with combustible breath.
- That creepy homeless guy? - I don't think he's homeless.
How about we wait till he sobers up? I'll be home in bed by then.
- He needs to be examined, Pratt.
- I'll take care of it.
- How long has he been here? - Oh, about two hours.
He thinks he's in an airport.
- He's altered? - Yeah, a little.
You ask me, we need one line for legitimate patients - another for the rest.
- Good thing nobody asked.
UTl, dislocated shoulder, and rapid hair loss all need to be signed out.
I haven't been this starved since the last Burning Man festival.
- Who wants some 'za? - You just had a burger.
- Fast metabolism.
- Pratt.
Wheezing guy was driving insomnia lady crazy.
- So I moved him into Exam 3.
- Okay, beautiful.
Okay.
Who's the lucky bastard that gets to take my blood? - I need CBC, LFTs and amylase.
- I'll do it.
- Is this about your needle stick? - Yeah.
Well, you gotta do what you gotta do, right? This is Dr.
Barnett from County.
I'll take six- No, make that seven.
Two pepperoni, two sausage and pepper, two Hawaiian and one with the works.
It's, let's see, 11:23 right now, so we'll get that at 12:03, right? All right, man.
Cool.
Seven pies? What was that about? Guaranteed delivery within 40 minutes or there's no charge.
What the guy doesn't know is Wacker's closed and The Loop is a parking lot.
There is such a thing as a free lunch.
Luka, belly-pain guy's going down.
Somebody bring a gurney.
Sir? Open your eyes, sir.
Hey, doctor.
No way.
I was here before him.
Vitals were normal when I triaged him.
That nurse told me I was next! Diaphoretic.
Carotid's weak and thready.
- Seventy systolic.
- Is that what it takes? Flopping around on the floor like I'm dying? Yeah, don't push me! Watch me! - Hey! Watch! Okay, here we go! - Get him on O2 right away.
Hey! Look at me! - Look! See me? - My bag.
- My bag.
I want my bag.
- I got it! Start the EKG in case he's having an Ml.
What about me, huh? I might have an Ml too! Any history of hepatitis? Abby, can you give us a hand? - What about my blood draw? - I'll write you a note.
- What are you doing? - Get a 12-lead going.
- Where am I? - Sam, got the IV? - What are you doing? - Okay.
- Hey, Pratt, can you spare Jane? - Definitely.
Document everything we do and the time.
- Isn't that usually a nurse's job? - There's a nurses' shortage.
- Haven't you heard? - What are you doing? Stop! - I may not know what to write.
- I'll tell you.
Start with two liters of O2 at 11:25.
Pulse ox, 98.
That's my bag.
Give me my bag back.
- I'll give you your bag back- - Get your hands off of me! - Calm down.
- Knock it off! Okay? We're here to help you.
We can try the nice way or we can try other options.
- This is how you help? - Yeah, that's right, sir.
JVD is 10 centimeters.
The EEG is printing.
- Chart it.
- Eleven twenty-six.
- Got your line.
What do you want sent? - Abby? CBC, Chem-20, PT/PTT, troponin, type and hold.
And add a serum ammonia.
EKG looks good.
There's no ischemic changes.
Excuse me.
Excuse me.
Hey.
Hey! Hey.
My name is Charlie Metcalf, okay? - Okay? - Okay.
- Okay? - Okay.
- Don't! - Okay, I'm not gonna hurt you, okay? - Dr.
Kovac.
- Okay, let's get him gowned.
We need you to work with us, Mr.
Metcalf.
This will be much easier.
- What's the trouble? - Possible extensive tendon lac.
Okay.
Can you move your toes up and down? - How did that happen? - My sister pulled the television down.
It was an accident.
I guess it's true then, huh? TV really is bad for kids.
- Where were your parents? - My dad was at work.
- Babysitter? - We can't afford one.
I watch after Steffie.
Can't afford a babysitter but they got a TV.
- Luka? - Somebody call the dad? The neighbor who brought him in.
Get him cleaned up and send for x-rays.
We have three TVs.
- That IV making you feel better? - Yeah.
Yeah, look.
Before- I'm sorry.
I just was getting a little- Eleven twenty-seven, 300 cc bolus is in.
Pulse down to 110.
No murmur, rubs or gallops.
Multiple spider angiomas on the chest wall.
Watch my stomach.
Watch- - Have you seen a doctor lately? - It's been a couple of years.
- Do you have a primary-care physician? - No.
Not at the present time.
- I need a 5-0 nylon.
- Over there.
Who were you seeing a couple of years ago? I don't remember the guy's name.
Some doctor in Taylorville.
Taylorville? - You live there? - Yeah.
- There's a prison there, right? - Yeah.
It's a correctional facility.
What's the big deal? - I knew somebody who spent time there.
- Yeah, small world.
Positive fluid wave.
Liver is small.
- Ascites? - Yeah.
What's that? It means you have fluid in your belly.
- So, what were you in for? - A mistake.
What you mean? You weren't framed? Spleen's enlarged.
- Chart a BP, 100/70 at 11:28.
- Caput medusae.
What kind of mistake? I killed a guy.
Palmar erythema and muscle atrophy.
- Oh, yeah? For what? - For asking too many damn questions.
- HemoCue is 7.
2.
- Yeah.
- My dad here yet? - No, not yet.
- Hey, kid.
- Don't look at him.
Just look this way.
- Hey, pally.
- Don't worry about him.
- Mr.
Metcalf.
- What? Mr.
Metcalf, you're very anemic and you could be losing blood from an ulcer.
- You a drinker? - Yeah.
- Drinking in jail? - Yeah.
Not gonna rat me to my parole board? Important we know what you've been taking.
Pruno.
Breakfast of felons.
Now I drink wine, beer, I don't know, anything I can get my hands on.
- Pruno? - Yeah.
It's fruit- Fruit and bread from the cafeteria.
You put it in a garbage bag with toilet water and then you let it ferment.
- Ferment where? - Under the bed.
You strain it through your socks and then you're ready to go.
If you're desperate, it tastes like a martini.
Oh, yeah? Yeah.
You don't know what it's like to need a drink.
- I can imagine.
- Yeah.
To check for blood loss, we're gonna have to do a rectal exam.
A what? No, no, no.
I spent the last nine years avoiding rectals.
No.
- It's the only way for me to know- - You gonna stick your finger up my ass? - My gloved and lubricated finger, yeah.
- No.
No.
It's smaller than your bowel movements.
Listen, boss.
Exit only, you understand? Exit only.
If you're bleeding internally, it could be life-threatening.
Okay, fine.
Can I-? Maybe we can cover me up or something? - I don't want it! - Hey, man, would I hurt you? No! I don't want it! I'm not gonna hurt you, okay? - I want my dad.
- Don't have to worry.
- Where's my dad? - Look at me.
I'm not gonna hurt you.
I want my dad! - I don't wanna get a shot.
- I'm not gonna hurt you, okay? Pally? - What's your name? - Jeremy.
Jeremy, you know, the way I see it, doctors are mean.
They wanna make us cry.
But you know what? If you don't, I won't.
What do you say? Let's show them.
Let's both not cry.
Okay, kid? Okay, Jeremy.
It's okay.
It's okay.
It's all right.
See? That's it.
Don't worry.
It's okay.
There it is.
Good job.
That's it.
See? Hey, that wasn't bad, was it? We have to put a tube down your nose into your stomach to figure out what's causing the bleeding.
No, the docs in the joint gave me one of those for my pancreatitis.
We're gonna numb it up so it won't be so bad.
We won't keep the tube in any longer than necessary, okay? Sit him up.
- You know I used to be an artist? - Open.
Pressure's up to 110/76.
- What kind of artist? - I did some painting.
A mural for my wife's church.
You know, mostly I earned my living as a contractor a carpenter, that sort of thing.
Fixing old places up.
Y'all could use my help around here.
If you swallow it while we pass it, it will go down easier.
All right, all right, all right.
Okay.
It's going down.
Keep swallowing.
It's going down.
That's good.
Very good.
All set.
Relax.
Okay.
Hook it up to low suction.
I was mixed up before.
I get confused in my head.
But I'm better now.
Like you think you're going on a trip? In the waiting room, you kept asking me what time your flight was.
Sometimes it's a train or a bus.
Sometimes it's a boat.
One time I was getting ready to parachute.
- Is that what the suitcase is all about? - No, I always have that.
You leave anything at the flop, it won't be there when you get back.
Those scumbags steal it.
NG output is one liter at 11:32.
Looks too dark for an ulcer.
- Varices? - What's that? That's when the elevated pressure in your liver backs up.
The veins of the esophagus become engorged and can bleed a lot.
Sometimes uncontrollably.
Emesis basin.
You made me worse.
- Get it out of me.
- No, no.
- That has to stay in.
- Get it out of me! Okay, soft restraints! - Get the tube out.
- Pressure's dropping, 82/66.
- Tachy at 130.
- Two units of type-specific.
- And call Gl down here now! - He needs a room.
No, no, no.
Don't, don't.
Trauma 1 is open.
Okay, Mr.
Metcalf, is there anyone we can call for you? - You mentioned you had a wife.
- No.
- Children? Siblings or anyone? - Nobody that will come.
Let's get him to X-ray.
You stay with him, okay? - I'll see you in an hour.
- Pratt, with us.
Make it four units, type-specific.
Take too long.
Get O-neg out of the cooler.
Get these off me.
Don't tie me down.
You can't keep tying me down! Let's go.
Prime the rapid infuser.
- Subclavian on the right? - Prep the chest.
- Let's go.
Prime the rapid infuser.
- Subclavian on the right? - Okay, prepping the chest.
- O-neg here.
Squeeze in the first unit.
Sam, second on the infuser.
- Pratt- - Push the octreotide.
- Been paying attention, huh? - Need me to do something? Yes.
Cycle the dynamap when it's ready.
A little Sandostatin's not gonna make his chances any better.
- It will diminish blood flow.
- But what's the point? - The odds of him making it are what? - Another 200 cc's out the NG tube.
He's that sick even though he was just lucid? He's on the edge.
All he needs is a push.
You know what? We got a lot of hands in here.
- You don't wanna help- - You're an Attending now? - No one wants to be a nurse anymore? - Pratt, come on.
- Prick.
- That's enough! - Heart rate's up to 140.
- Is he taking any meds? Check his bag.
He said all his stuff was in there.
- First unit's up.
- Eleven thirty-five.
- Pushing 50 mics of octreotide.
- All right.
Guide wire's passing.
Yo, hair of the dog.
- A hundred and fifty-one proof.
- This guy's a class act.
- Ready with your extension tubing.
- What's your problem? We're killing ourselves for a non-compliant, alcoholic - ex-con with end-stage liver failure.
- You wanna get out? Get out.
You know what? It's Friday.
I don't do lost causes on Friday.
It's a religious thing.
Second unit's going in.
Anything else in that bag we need to know about? No, but there's a picture.
It looks like him and his wife and a kid.
Here's a bunch of letters, a journal.
Pressure's 98/62 at 11:37.
And I don't know, some kind of painting.
- Where's my passport? - Where's your what? Give me my passport.
- I can't go without my shoes.
- Go where, Mr.
-? - Let me go.
Let me go.
- Okay.
- Head up to 20 degrees.
- Let me go.
- And check on Gl again.
- Let me go.
Thank you.
- I'll be right back.
- Get them off.
Get them off.
Do you have a problem with me? - No.
- It's him? - I was out of line.
- Okay.
Let's go.
The guy's a waste, dying from something that he's doing to himself.
Last time I checked, alcoholism was a disease.
So was suicide.
He should catch that and save us the trouble.
- We get ones like this every day.
- Then maybe I need a day off.
- It's personal? - I guess.
Good.
Then we don't have to talk about it.
- You like riding me? - I don't think I do.
No.
Ever since I was an intern, you've been on my back.
- Maybe a couple of times.
- Why? You're good, Pratt.
But I think you could be better.
There's a number you wrote with a name.
Bobby? Should we call him, Charlie? No.
No.
Don't call him, please.
I don't want anybody to call him.
- Okay.
- Okay? You understand? No calling.
- I don't want to see him.
- Gl's on their way.
Mr.
Metcalf, the veins at the end of your esophagus are bleeding a lot.
This is a result of your cirrhosis.
That also means you have less than a 50-percent chance of surviving.
Less than surviving for how long? A few months? "Months" months? What-? What? Not that long.
What we need to know is, if you stop breathing or your heart gives out do you want us to use heroic measures? Do heroic what? Do you want us to do CPR, shock your heart - or put you on a breathing machine? - Wait, wait, wait.
You're saying now? You're- You're saying now? You mean, like, today? No, no, no.
Look, no.
I have a lot of things that I have to do.
- Okay.
- I'm just not ready.
I'm not ready.
- I'm- - Okay.
Okay.
The man wants it all.
Okay.
I'm Adler from Gl.
How bad? About two and a half liters of output.
Pre-load the scope with a Saeed Six-Shooter.
What? What's a Six-Shooter? We're going to look down your esophagus and try to bend the veins to stop the bleeding.
- What's the deal with your suction? - Turn it up.
- I did.
- Nothing's coming out.
- Great.
- Check in 2, Abby.
Jane, get on the phone about a portable.
- You guys have suction in here? - Last time I checked.
- What time is it? - Eleven forty.
Why? They got 23 minutes or we eat for free.
- Hey, is your patient stable? - Smoke inhalation with wheezing.
- Okay.
We need the room.
- You into pepperoni, Abby? - You have ADD? Come on, let's go.
- Give us two minutes to finish.
- We need it now.
We're good here.
- The guy just needs to be tubed.
- This guy might need to be pronounced.
- Hope you're not a veggie - because I got meat on everything.
- See you later.
- Cetacaine and bite block.
- Little more numbing spray, Charlie? Okay, push two of Versed.
All right, Charlie.
Once we're ready to start you're gonna have to keep this between your teeth.
It stops you from biting the fiber-optic scope.
- Check the monitor.
- Is this Bobby? - Charlie? Is that your son? - Yeah.
Yeah.
- And your wife? - Evelyn.
Pretty.
You want me to call her? No.
No.
She's gone.
It's been a long time.
Well, what about Bobby? He must be all grown-up by now.
Yeah.
He's 19.
He's gonna be 20 next month.
He's in college.
Well, let's try to reach him, okay? I haven't talked to him since he was little.
His aunt gave me that number when I got out of prison, but I- Well, that's all the more reason to use it now.
Let's pull the NG.
Okay, Charlie.
Here we go.
- How's pressure? -108/58.
- Okay, ready to go.
- Hi.
I'm looking for Bobby Metcalf.
Okay.
Yeah.
You know what? Can you actually wake him up for me? Hi, Bobby? My name is Samantha Taggart.
I'm a nurse at the County General in Chicago.
- Grade-two varices? - Grade three.
Yeah.
We have your father here and Yeah.
And he's pretty sick.
Four columns, two hemorrhagic.
Two bands at each bleeding site, one at the others.
No- He's out.
Well, he's out of jail, yeah- - I don't know.
For a while, I think.
- Systolic's down to 90.
Is there any way you can come here and be with him? - Probably the Versed.
- Five-hundred cc saline bolus.
No.
You know what? He can't talk right now because he's in a procedure.
Sucking the varix into the cap.
Wait- Okay, hold on.
He wants to talk to you.
Sorry, that needs to stay in.
And firing.
Okay, let's talk.
Okay, guys.
I'm gonna put Mr.
Metcalf's son on the phone for a minute, okay? Bobby? - Dad? Is it you? - Yeah.
- It's me.
- So you're sick, huh? You dying? - No, no, no.
- Nurse, is he dying? He's very sick.
What am I supposed to say? Huh, Dad? It's been a long time.
So many things I- - Y eah.
- I don't know.
I- - Hey, Dad.
- Y eah? Nice knowing you.
I told you, you shouldn't call him.
Firing.
Good.
- Turn up my suction.
- Can you band it? - Not if I can't see it.
- Mr.
Metcalf? - BP 68/32.
- Mr.
Metcalf? - I can't even feel a pulse.
- Bobby.
Bobby.
- Bobby! - He's bleeding out.
Okay, turn him over.
Another two units on the infuser.
Ambu-bag.
Come on in.
The water's warm.
- Try the femoral.
- Get another four units up here.
FFP after these two.
Hey.
Hey, you dumb son of a bitch.
Hey, you dumb son of a bitch.
Thought we lost you there for a second.
- Bobby? - We had him on the phone.
Is he coming? No.
No, he's not coming, man.
BP's 86/42 at 11:44.
- Want the FFP? - Yeah.
And another unit of packed cells.
Dr.
Kovac.
How long have you been out of touch with him? Your son? A long time.
Since I went to prison.
Well, even in prison, he's still your kid.
Blood's here.
You don't know what it's like.
If I had a kid, I'd do everything I could to stay with him.
Need a Linton tube, a Kelly, and a 60-cc syringe.
You think you know, but you don't.
How it could all switch on you.
Life could turn on a dime.
Gets broke and you can't- You can't see a way to fix it.
Mr.
Metcalf, the specialist thinks we can't control the bleeding with the scope.
- So you want a Linton tube? - What? We pass a large balloon into your stomach.
So it helps us keep pressure on your veins.
All right.
What's there to lose? I'll test the balloon.
It was April 10th, 1992.
When Bobby was turning 8.
My wife asked me to go get some stuff for the party.
But I stayed so I could finish putting together this robot for him.
You know, so I made her go.
From the street I hear a thud.
This scream.
And I go to the window to look out.
And she's lying there like she's asleep on the street.
And ice-cream cake- Ice-cream cake was all around her on the pavement.
Five syringes.
So there I am.
There I am with this little boy to raise.
And what do I do? I start drinking.
I get high.
I can't keep it together.
I can't keep it together.
Then I stab some guy at a bar.
Just for- Just for nothing.
For nothing.
Because he looked at me wrong.
This one's good.
We can go up to 750 for hemostasis.
Okay.
Ready, Mr.
Metcalf? So where was your son after that? With my wife's folks.
Listen for bowel sounds.
At first they would bring him by on visiting days but after a while that stopped.
Then the letters started coming back unopened.
You know what? I don't feel good.
Something's wrong.
Something's wrong.
BUN, 74.
Creatinine, 8.
2.
Okay.
Call Renal and throw in a Foley.
Hey.
We should think about TIPS.
What's that? TIPS stands for Transjugular Intrahepatic Portosystemic Shunt.
It- We put a catheter from your neck to your belly.
By bridging the two vessels, we bypass the liver and slow down the bleeding.
- How much time would that give me? - It's hard to say.
- No urine output.
- Hepatorenal syndrome.
- Your kidneys are not working.
- He needs dialysis.
I'll make the call.
- Okay.
GSW to the belly.
- Not here, Chuny.
- There's nowhere else.
- Okay.
Move him over and keep traction on the Linton.
Hold on.
Okay, go ahead.
Okay, let's transfer him.
One, two, three.
No meds, no allergies, no past history.
NG, Foley, and a portable chest.
- Bastard shot me for stealing my spliff.
- I need another nurse.
Said it was his, but it was mine.
Rolled it this morning.
- What's going on? - They need to stabilize him.
I want my own damn room! Get the hell out of here, man.
- Screw you, jerk-off.
- Okay.
Doctors only talking now.
Damn, that's hard.
Even a gunshot in the belly don't buy a man some privacy.
Okay.
Two grams of cefoxitin, IV piggyback.
It's a house we rented one summer.
There's a lake there by it.
I took Bobby fishing there.
Periumbilical GSW with intestinal prolapse.
- All right.
What about the on-deck batter? - We're waiting for a TIPS and IR.
That sounds bad.
Let's get him up for an ex-lap.
Portable monitor.
Let's go.
- What about x-rays? - Get them upstairs.
T minus 11 minutes on those pizzas.
IR's already on the floor.
Renal's on the way.
Luka, he's getting tremulous.
I haven't had a drink since last night.
- It's alcohol withdrawal.
- Dr.
Pratt? - Yeah, that would be me.
- Hey.
Ramirez, Nephrology.
- Who's this guy? - We're gonna need central access.
- He's got a subclavian.
- That's great.
- Let's consent him and start the run.
- What? What is he talking about? He's here for the dialysis that we discussed.
I never discussed it.
You discussed it.
I never discussed it.
- Alfonso, how are you? - Is this a TIPS patient? Yeah.
And we should go first.
- What are you talking about? - That's what's gonna prolong his life.
Without the dialysis he'll bleed out the minute you spike his liver.
What? What-? Spike my liver? Will his pressure even tolerate dialysis if the varices bleed? - I don't understand.
What-? - I can support his pressure.
The Linton is supporting his pressure.
- What are you talking about? - Dr.
Kovac? Well, he's gonna need dialysis three times a week.
- Oh, yeah.
For the rest of his life.
- TIPS is not a cure.
- It's a bridge to a liver transplant.
- We know that's not gonna happen.
Hey, hey, hey.
I'm right here.
- Yeah.
- Talk to me.
Sorry.
Now, you can't fix my kidneys? You're gonna need dialysis three times a week.
And what about my liver problem and the bleeding? - The TIPS is a temporary measure.
- Your best hope is for a liver transplant.
I don't understand.
What are the odds of that? Based on your history of drinking, not good.
Is there any chance that I'm gonna be walking out of here? With the dialysis and the TIPS- I mean, today.
What are the chances that I'm gonna walk out of here today? None.
I don't want it.
I don't want anything, then.
If you don't have the TIPS procedure, we can't control the bleeding.
- You'll die.
- Yeah, I get it.
I get it.
Just stop everything.
- No blood transfusions? No breathing-? - No, it's over.
- No CPR? - No.
I need it to be very clear, Charlie.
If we don't continue with the treatment, do you understand what could happen? Yeah.
Yeah.
Okay.
Mr.
Metcalf is a DNR.
Eleven fifty-seven.
Wait.
Wait a minute.
Wait a minute.
Hey, hey, he's not competent.
Come on.
That's what he wants, Pratt.
Can you-? Can you do something for this? Hey, could we put him on an alcohol drip? - You're gonna get me drunk? - Just enough to stop tremors, Charlie.
Charlie, let us do the procedure.
You don't have to do this.
Call Try Bobby again.
Try my boy.
Get him on the phone.
If he knows it's really over, he'll come.
Okay? He'll come.
Hey, Bobby Metcalf? Oh, yeah.
It's the hospital calling again.
Yeah.
Do you think you could do that? Okay.
Thank you.
- What happened? - He went to class.
His roommate's gonna see if he can find him.
Can you take this out? It's uncomfortable.
- The tube's keeping you alive.
- It's uncomfortable.
Please.
Okay.
Is there-? Is there a window? Can you open a window and get some fresh air in here? Please? - Sam.
- Please.
All right.
Here we go.
- What is that? Lincoln Street? - Harrison.
I've worked here over a year.
Never thought about what was outside.
I worked here for six.
It's from the tube.
I'll take care of it.
Ten percent ethanol at 100 cc's an hour.
You know, your booze works fast.
Mad Dog IV, just for you.
All this stuff, you know it's just blinders.
It's just a screen.
I don't want anything separating me from what's happening.
I'm not gonna run and hide from this.
Pulse ox and dynamap can come off.
Last sats, 92.
My brother Lou died when we were kids.
My mom, she said She said, "Charlie, Lou's gone away on a long trip.
" Don't you just leave me here.
I wanna see a doctor now.
Last sats, 92.
When is my turn, huh? When is it going to be my turn, huh? People? When is it? When is my turn? Pulse, 104.
Resps, 18.
Temp, 98.
2.
Ninety-two.
One-oh-four.
One-seventy.
Ninety-one.
- What are you saying? - It's your vitals.
- Is it starting? - What, Charlie? Am I going? It's starting.
Don't you people have a system? Isn't there any method at all? Don't worry.
You won't be alone.
Good.
That's good.
Someone will stay with you.
Sam, you get this? Could you touch me? Sorry? My face? Please? Maybe we should anchor.
- What? - Do you think we should keep going? I don't know, Charlie.
Well, what about him? What do you think he wants? I don't know.
I don't think he knows.
Is it too late? Not if you don't want it to be, Charlie.
Watch it! Oh, no.
Oh, no.
Oh, no.
I feel drunk again.
- Yeah.
- Thank you.
Sure.
Okay, Mr.
Metcalf.
We're gonna keep a heart monitor on - and the alcohol drip for comfort.
- Okay.
I wanna take you off the octreotide now which is the last support measure.
Okay.
- Shouldn't be long now.
- Okay.
I never believed in God.
That might bite me in the ass now, huh? God will get over it.
Do you need this? - Can I take it? - Take it.
Take it.
What? - What can I take? - No, never mind.
Never mind.
What's it gonna be like there? Peaceful.
- Come back.
- Charlie.
Charlie.
Get all my stuff? Oh, yeah.
Yeah.
Make sure he gets it.
I will.
And give this to him.
You never knew your dad.
No.
That's too bad.
I don't let it bother me.
I bet it bothers him.
Bobby.
Let me in.
Open up.
Let me in.
Charlie, can you hear me? Charlie, can you hear me? Hey, pally.
You made it.
How do I look? You look okay.
I'm so sorry.
I'm so sorry.
Don't think about that.
Okay? Just take it easy.
It's okay, son.
It's Twelve-oh-four.
I'll take that.
Can someone just tell me that? How much longer? Ma'am, you need to wait in the room.
Let's go.
It's about time.
Been with the same patient for almost 45 minutes.
Whatever happened to "treat them and street them"? Do as I say, not as I do.
All right.
The TV kid's back from X-ray.
He's in Triage with his dad and his sister.
Things go south? He was a nice guy.
Just a drunk.
There's pizzas over here if you get hungry.
Got you one with anchovies.
Oh, and the delivery guy got here at 12:04.
You know what that means? It means he didn't make it on time.
Means lunch is on the house, my friend.
Hey, Jeremy, little man.
Back so soon? Hello, I'm Dr.
Pratt.
I'm the one who treated your son.