ER s11e21 Episode Script
Carter est Amoureux
E.
R.
Previously on E.
R.
- You won't tell me how you feel.
- Because it's fine.
If you're having trouble, see a therapist.
If you can't, work separate shifts.
This is our niece, Shelley.
I just found out they were here.
We're waiting on Social Services to come down here.
It was my father's.
I want you to have it.
It suits you.
E.
R.
11x21 "CARTER EST AMOUREUX" Surveying your kingdom? I was just wondering, what do they do with all the dirt? When is it supposed to open? A year from September.
Hey, congratulations, by the way.
Tenure.
Thank you.
What? That's not a good thing? No, it's good.
It's great.
So you got about two weeks left on your internship, huh? You ready to be an R2? Do I have a choice? Can't believe it went so fast.
I don't hear many interns say that.
Who's Joshua? - Family member.
- Yes, I got that from the "Carter" part.
Joshua's what Kem and I were gonna name the baby.
It's a good thing you're doing here, John.
If Surgery's mad some guy went up without a central line, they scream.
Gl's pissed some ulcerative colitis went home without follow-up - who do they yell at? - Me.
You got it.
You also have office hours for the med students and Residents to stop by if they have any problems or questions.
- I get an office? - Well, other chiefs haven't really used it.
Where is it? Morris, "office hours" is just a figure of speech.
Just make yourself available at Admit.
You're the new head cheerleader.
Organize parties, treats for Residents working holidays, host happy hours.
- Do I get a budget for that? - Yeah.
It's called your ATM card.
Next year's Resident contracts.
Sign them and have them in my box by the end of the week.
Dr.
Barnett, we need to find time to talk about yours.
- So you two work together? - Yeah.
In the ER at County.
I'm a nurse.
Luka's a doctor.
Must be challenging.
Can be.
Place is an insane asylum.
How long have you been together? About a year, on and off.
Mostly on.
Have you sought therapy before? No.
So, what brings you to me today? I don't think Luka and I should be together.
Another four of MS along with two of Versed? Was that a statement or a question? - Four of MS, two of Versed! - Want Ativan? - Oh, God! It hurts! - No.
It has too long a half-life for pre-op assessment.
- Calm down.
- What's all the ruckus? Mr.
Lillion was checking radiator leaks while his engine was running.
- I caught my hair in the damn belt! - Avulsed his whole scalp.
- Okay.
- Then he tried to pull his hair out of the moving fan with his hands.
Open fracture of third and fourth metacarpals.
- And extensor-tendon lacs.
- You want antibiotics? - A gram of Ancef IV piggyback.
- Anything else? A hundred of gentamicin.
Why gent? Because open fractures are susceptible to Gram-negative organisms.
Pratt.
Some guy out front says he's a friend of yours.
- What's his complaint? - Nothing he'll tell me.
- Says he knows you from high school.
- Go.
I got this.
- Darnell.
- Greg, how are you doing? - What's up, man? - My boy.
- Remember K.
J.
, right? - Yeah.
- What's up, little man? - Get up and say hello to Dr.
Pratt.
- Where's the love at? - Right? - Getting big.
- Tell me about it.
- What's up? - Somewhere we can talk? - Yeah, yeah, yeah.
- All right.
Be right back.
- I'm happy.
- No, you're not.
- I'm not.
- Nobody is happy all the time.
He's like a sphinx.
I never know what he's thinking.
We talk.
We don't talk.
I talk.
You sit there and smile.
Occasionally, you nod.
And then I get mad.
I'm always the one getting angry.
- I'm always the one yelling.
- You want me to get angry? Yeah.
That would be nice.
Could you break a dish or scream at the top of your lungs? Something.
That's what I'm talking about.
What are you feeling, Luka? I'm happy.
I'm happy and Sam's not.
I don't know why.
We're healthy.
We enjoy each other, our work.
We have a good life.
How does that make you feel, Sam? Like hitting him over the head with a hammer.
Was there a particular event or series of events that led to your decision to come here today? Yeah.
I thought that I might be pregnant.
- And are you? - No.
Thank God.
- That's a pretty unequivocal answer.
- Yeah.
It's how I feel about it.
Is that how you feel about it, Luka? What is that? Hey! What the hell is that? What's what, Billy? That up there coming out of the damn ceiling.
It smells like crap.
- It is crap.
- Okay.
Bad enough I'm stuck in here, you gotta let the building crap on me? I think it's just your DTs kicking in, Mr.
Seiger.
Hey! Hey! Unless they're passing out ponchos better get him back in the ambulance and over to Mercy, pronto! - Jake's in Philadelphia? - Tulane.
- He was in San Francisco.
- Couple weeks ago.
Something disgusting is leaking out of the ceiling.
Call Maintenance.
That or a HAZMAT unit.
So Carter gets tenure and Dr.
Lewis doesn't? - Yeah.
- How do you explain that? Lewis has more seniority.
She runs ER.
Bada-bing.
Show me the green.
Hey, anybody seen Carter? He's got African love on the overseas line again.
He took the avulsed scalp.
Sorry, Kem.
Can I take a message? So you get tenure based on how much money you have? He's building a wing for the hospital.
She's pushing paper and banana bags.
Highly-qualified woman, well-liked man.
Who do you think? Oh, put your bra back on, Gloria Steinem.
Carter's been here 10 years.
Lewis split and then came back.
It's a level playing field now.
Haven't you heard? Ix-nay on the Lewis-nay.
Dr.
Barnett, do you have a minute for me? Sure.
- So, what? He interested in medicine? - No.
But he's got to do his community-service hours somewhere.
- What did he get busted for? - Tagging.
Had some weed on him too.
Hey, we did a lot worse, just never got caught.
Yeah, speak for yourself.
It ain't my fault I ran faster.
All right, look, on the real I'm just a hired hand around here.
It's not really my decision to make.
But you'll ask? - Yeah, man.
- My man.
- I'll ask.
- My man, 50 grand.
Because I don't think it would be fair to Alex.
Alex is? My son.
He doesn't have enough problems without feeling he's getting elbowed by a baby.
I think Alex would like a brother or a sister.
A family.
- He has a family.
- Okay, hang on.
Hang on.
Time-out.
Luka, issues revolving around having children can be complicated when one person in the relationship already has a child.
God, Luka.
I didn't wanna have a kid the first time.
Alex was unplanned? Yeah, you could say that.
- I was 15.
- Well, you're not 15 anymore.
After what happened to your wife and kids you really want to bring another baby into this world? You had a family before? He says he's happy, and he can't even talk about it.
I had two children and a wife.
They were killed years ago.
How does it help us for me to talk about these things? It's a huge part of who you are, and you won't let me in.
How come every kid named Destiny, Miracle or Faith ends up with leukemia? Alkalinize her fluids and give Oncology a heads-up.
That scalp guy went to the O.
R.
Oh, you got another call from your Kenyan love nest.
It's the Congo, Frank.
And I know that you know it's the Congo.
Kenya, Congo.
It's all mosquitoes the size of flying toasters to me.
She sounded kind of upset.
You're all set.
Gonna leave that bucket in the middle of the floor? Shut off the toilet in O.
R.
Soon as it drains, we'll snake it.
So how long we gonna have raw sewage seeping out? Another hour or two at the most.
Okay, great.
So when the bucket's full just toss it into the street like we do chamber pots.
Kem Likasu, please.
Is this Charles? Hey, Charles.
It's John Carter.
Good, good.
Is she around? I found the Chief Resident's office, but there's boxes I need you to move.
- She what? - I look like Beakins to you? Get a couple of your interns, lean on them.
- See, but they're busy and you're not.
- What happened? Ray, honestly, what are you doing here? This is a great program.
You were lucky to get into it.
- And you're just taking up space.
- You don't think I'm a good doctor? I think you could be a very good doctor, but you know what? You watch the clock all day just waiting to punch out.
You have two weeks left on your internship.
Take your degree and go work at a doc-in-a-box or do air transport.
If you're doing this to make a living, you don't need a specialty.
You make more than enough money right now to support your music.
Don't sign this contract unless you are sure this is what you want to do.
Did something happen to Kem? No.
It's her mother.
She's in the hospital.
- In Africa? - No.
Her mother lives in Paris.
- Did she say what happened? - Didn't talk to her.
She'd already left for the airport.
Hey, Frank.
I don't know where Susan is.
- Would you please tell her I had to go? - Go where? Just tell her that I'll call her from O'Hare, okay? Gotta go by the bank on the way back if that's okay.
Do you need anything from Home Depot? - I thought I'd swing by before work.
- Home Depot? Yeah.
I need to get some anchors to fix that towel bar Alex pulled down.
- Where are you going? - Leave me alone, Luka.
Are you gonna walk? It's gotta be five miles.
Towel bars? Sam! - What's he doing in Paris? - Kem's mother is sick.
Meningitis.
She's immunosuppressed from chemotherapy.
With Carter AWOL, you and me pick up the slack.
Five night shifts in a row? - What? - The new schedule.
Morris? If that's what it says.
A swing shift and a day shift back-to-back? - And Ray gets every weekend off.
- What? - Cubbies-Braves, right? - Got you covered.
- All right.
- Oh, I see.
- So he bribed you for a good schedule.
- Of course not.
That would be unethical.
Oh, I hear U2 tickets are hard to get.
It's a shame.
I really wanted to go.
Dr.
Lewis? He is the chief.
Any way we can make Abby Chief Resident? Morris isn't the sharpest shovel in the shed.
But he's a paperwork hound.
Besides, keeps him from seeing patients.
Think of it as community service.
- CT call on Werntz yet? - I'll call them again.
- Flowers usually work.
- Hey, Jerry, I want you to meet K.
J.
- He's our new volunteer.
- Volunteen, welcome.
Jerry will be telling you what to do.
Jerry, just have him run specimens up to the lab or whatever.
- Specimens? - Yeah.
Blood, urine Piss? Nasal swabs, wound cultures, stool samples, the whole enchilada.
Hey, Pratt, 47's pulling in with a septic newborn.
Hey, you don't like it, the door's that way.
Stool sample is what I think it is? - Septic newborn? - So they say.
Hey, study your antibiotics last night? The gentamicin for the open fracture.
You should know this stuff cold by now.
Gonna be an R2 in a couple weeks supervising new interns.
- Gotta start stepping it up.
- Eight-day-old female, febrile to 104.
Grunting, severe retractions.
Can't get a pulse ox.
- Tachy to 192.
Resps, 80.
- Started this morning.
- I thought it was a cold.
- Access? I had a 23 gauge in the hand but it blew.
Fabienne Elmont? John? Hey.
What are you doing here? I got your message about your mom.
You should have told me you were coming.
Well, I called your cell.
No.
It doesn't work in Paris.
How's she doing? I can't tell what antibiotics they're giving her from the IV.
Oh, she's not on antibiotics.
They're not giving her antibiotics for meningitis? Viral meningitis? - Who told you she had meningitis? - I called the clinic.
Charles said you flew to Paris.
With all the chemo, I just assumed that - So she's okay? - She had a fever, the doctor got worried.
So he admitted her.
But she's much better now.
Good.
John, this is an old friend of mine, Michel Timbaud.
BP's 58/29.
- She needs volume.
- You're hurting her! Can't help unless we give her fluids, medicine.
I'm in.
Portable x-ray.
Call RT for a vent.
- Good chest rise.
- All right.
Airway and access.
Neela, what's your plan? Normal saline, CBC, blood culture, amp and cefotax.
- Good.
- Hodgkin guy's pressure - dropped after antibiotics.
- Run a liter.
- He's trying to pull out his broviac.
- Give the bolus.
I'll be back.
- Hundred cc's MS through the IO.
- Please tell me what's going on.
We suspect your daughter has an infection.
Giving her antibiotics.
Fluids elevate her blood pressure.
Tube is helping her breathe.
- IO's infiltrated.
Won't flush.
- How old is she again? - Eight days.
- Umbilical stump is still attached.
- Is that bad? - No.
That's That's good.
Umbilical-line kit.
Five French.
Sterile sixes and 10 blade.
Hey, Jerry, Hodgkin's guy needs a Med bed.
Let NICU know they got a customer.
Your volunteen kid doesn't seem very interested.
- Yeah.
Well, he's not.
- So why has he volunteered? - He has to work off his probation.
- What did he do? - Second-degree murder, I think.
- Really? He got caught tagging a police car.
- Wait.
He tried to spray-paint a cop car? - Yeah.
With the cop still in it.
- The kid's got guts.
- Either that or he's an idiot.
Small-bowel obstruction secondary to a popcorn overdose.
A 6-year-old ate a huge tub of popcorn all by himself.
- Yeah, and? - Call Surgery, get a CT.
Think they'll be ready to supervise interns in two weeks? Not a chance.
John.
That was awkward.
Where are you going? Back to the airport, I guess.
You just got here.
Well, you were right.
I should have called first.
Michel and I went to school together.
And he's fond of my mother.
- You two a couple? - We were.
Does he know about the past-tense part? Are you jealous? Yeah.
Hey, don't do that.
Don't laugh at me.
Okay.
Okay.
Are you sleeping together? No.
Do not answer that.
Well, you haven't been dating? Is there someplace around here I can catch a taxi to the airport? - Don't be so dramatic.
- Okay, look.
I'm sorry.
Okay? I'm tired.
And I shouldn't have just barged in on you.
And I feel completely ridiculous.
Actually, it was very sweet.
Yeah.
Okay.
Look, I'm really glad that your mom's okay.
Why don't you call me when you get home.
John.
Just stay.
Just for the night.
- Flushes easily.
- Hook up the transducer.
- Sats, 93.
Systolic's up to 78.
- Good.
That's good.
How we doing in here? - What are you doing? - Umbilical lines.
- You what? - Umbilical lines.
I heard you.
Why? - IO infiltrated.
We needed access.
- Why not just put in another IO? She still has an umbilical stump.
UAC and UVC allow for frequent blood draws.
Gases Did she do something wrong? Hotel La Pavillon.
I'll come by in the morning.
We'll have some breakfast.
Michel coming too? - He has to work.
- Those his real teeth? - They're a little too straight.
- Get some sleep.
- I'm gonna come and pick you up early.
- Yeah.
You get some sleep too.
You can't be placing umbilical lines by yourself.
Do you know the things could've gone wrong? Thromboembolism, vascular injuries, arrhythmias - I thought arterial monitoring- - You're an intern.
You can't play neonatologist whenever you feel like it.
I did a bunch of these - when we rotated through the- - Really? When, two years ago? Have you done one, even seen one since then? - You told me to take more initiative.
- Initiative? What about common sense, Neela? What's next, neurosurgery in the lounge? You need to know when to ask for help.
What the hell is this? What, you're gonna cry now? All right, look, you got lucky this time.
She's stabilizing.
But you have to start using your head.
Now go on.
Get out of here.
Go.
I'll deal with the NICU guy.
Hello? I'm sleeping.
It's dark outside.
All right, I'm up.
All right, I'm up, I'm up, I'm up.
How's Michel gonna get to work if we have his car? Who said it's his car? - Come on.
I wanna show you something.
- Does it involve coffee? Everything in Paris involves coffee.
Hurry.
We're gonna miss it.
- Where are we going? - Nowhere.
We're here.
You got me up at 5 in the morning to ride a train? Will you be patient for once in your life? She spent the night at her dying husband's bedside.
He was a member of the Resistance fought bravely against the Occupation while she smuggled messages for the Free French through Nazi lines on her bicycle.
He still loves her.
She's not so sure after all these years.
He is an accountant.
She is a waitress, longed to be a singer.
She had a mad, secret, tempestuous affair with her sister's fiancé.
What about them? It's a sad story.
She only has a few months to live.
Cancer.
They love each other desperately, spend every moment together.
What about us? You have a story for us? Quick.
Close your eyes.
Quickly, quickly, quickly.
Come on.
Close your eyes.
Wait, wait, wait.
Now.
What are you doing out here? Deciding if I'm sick.
Pratt's on.
- Hey, Neela.
- Hey.
Got you a bear claw.
They don't have the apple fritters.
- What are we doing? - Neela's trying to decide - if she should go to work.
- We get to decide? She put in umbilical lines in a newborn yesterday.
- Really? Cool.
- Unsupervised.
Pratt became unglued.
I miss all the good stuff.
Well, gotta go.
I'm gonna be late.
Gotta get back on that horse.
Nothing fancy.
Just primer and a couple coats.
- The lichen- - I'm not painting your office.
- Hospital does it.
Need a purchase order.
- Yeah, that comes out of my ER budget.
Hey, Pratt.
Stabbing victim in Trauma 1.
Back up the interns, please.
Paramedics are two minutes out with an MVA, a 9-year-old kid.
Okay.
Luka, can you get that? I've got an extubation in C2.
- We don't have to do the trim.
- No, Morris.
MVA coming in.
Trauma panel.
Type and cross for four.
- Pulse ox to 78.
- Taking down neck dressing.
- Shouldn't we tube her first? - Be my guest.
- Maybe there's something we can tie off.
- Etomidate and sux.
- Got the jugular, but spared the carotid.
- Can't breathe.
You're just going to sleep.
We breathe for you.
Prep for subclavian on the right.
-8.
0 ET tube.
- Is this the penetrating neck? Single stab wound.
Hypotensive, no sub-Q air.
- Two of O-neg on peripheral IV.
- Pressure's up to 90 palp.
- I'm in.
Bag her.
- Got a flash.
We'll have a central line for the next 2 units.
Good breath sounds.
Excellent.
Maybe there's hope for you two after all.
Professor Carter.
It's associate professor, actually.
Well, I'm proud of you.
- Susan didn't get tenure.
- Susan Lewis? Really? She's pretty pissed about it too.
She's not talking to me.
Now, this is what I really miss in Africa.
Baked goods.
What? - You have a lot of jam on your face.
- Well, help me.
Hello.
- Hey, hey, got a minute? - Not really.
What's up? I gotta finish my rankings for my match.
- I could use a little advice.
- Excuse me? There's something leaking from the ceiling.
Okay.
We're gonna move you right over here.
And Christian's gonna take care of you.
Thank you.
- Is that what I think it is? - Yup.
Susan, code brown dripping from the ceiling again.
Damn it, that is it.
Jerry, call the AOD.
Tell them we are closed to trauma until someone comes down and deals with the raw sewage leaking from the ceiling.
Is this the respiratory distress? - Jerry, what's open? - There's a bed in Curtain 3.
Arnold Brixton, 65, short of breath.
Sats, 83 on room air, Tachy at 115, afebrile, good BP.
On theophylline for emphysema.
- Don't say it.
- Say what? I stopped smoking five years ago.
- Good for you.
- Come on.
So I was thinking I might rank County as my first choice.
You want to stay in Chicago? Yeah.
I mean, my friends are here, all my family.
He needs a monitor and continuous albuterol with 500 of Atrovent.
What about San Francisco? UCSF has a great program, but County has a lot to offer too.
Those sisters are back.
Okay, 60 of pred and a portable chest.
- And do you wanna talk about this later? - Sure.
- Rebecca? Birdy? You okay? - You know them? They've been in a couple times before.
Circumferential ecchymosis.
Neela wants to get a telemetry bed.
What happened? Rebecca almost got strangled to death.
I tried to tell you guys it's too dangerous for you to be out there on the streets.
I'd be dead if Birdy hadn't stabbed her.
You stabbed the attacker? Well, I had to.
Is she gonna be all right? Yeah.
I mean, she seems stable for now.
- We might have to - No.
Not Rebecca.
Shelley.
Our niece.
They're working on her in that room over there.
I grew up playing here, when we weren't in Kinshasa with my dad.
My mom would save the old bread so I could feed the ducks on the weekends.
There was thousands of them in the summer.
Sounds idyllic.
Yeah.
Yeah, it was.
So why did you leave? It was different when I was little.
We were a novelty then.
My very white mother, my black father, with their little brown girl.
It wasn't easy for them.
You know that Joshua would be a year old now? I'm gonna head back to the hospital, see my mother, okay? What are we doing? What are we doing? I still love you, and I know you still love me.
We talk to each other every day.
We talk for hours on the phone.
We tell each other absolutely everything about our lives.
I make you happy.
I make you laugh.
I tried living in Chicago and it wasn't for me.
- We don't have to live in Chicago.
- You have your life there - your career, everything.
- I would give it up for you.
I don't want you to.
Kem, we had a baby and he died.
It's a tragedy that happens to people and it happened to us.
But that doesn't have to define us.
It doesn't.
We're stronger than that.
Aren't we? - I can't- - We can have another baby.
Stop this.
Stop doing this.
I'm sorry.
I'm sorry.
Are you gonna come to the hospital? Because Fabienne's gonna want to say goodbye.
Tidal volume's 700.
AC 14 on 100 percent.
- Units three and four on board.
- Did you follow up with Social Services - on home visit for the Chadwicks? - I'm Who? The two old ladies that panhandle on the south.
You sent them home with their niece.
- From a few weeks ago? - Yeah.
- Down 60 systolic.
- Check for tracheal shift.
Get four of type specific.
This is the niece, Shelley.
Birdy stabbed Shelley.
- She was trying to strangle Rebecca.
- She what? You sent them home with Shelley.
Did you forget about the follow-up - or not want to deal with it? - I called.
But what do I do? - Make sure they do their job? - People - can we focus on the patient? - V-fib.
Starting compressions.
- Ambu-bag.
- Charge at 200.
- Cardiac history? - I don't know, Ray.
You're the only one that's met her.
Clear.
Oh, we're being rude.
No.
I'm hungry.
Will you get me something, mon ange? Thank you for the beautiful flowers.
He's a very handsome young man.
- Who? - Michel.
Well, yeah, I guess.
Also something of a fool.
- When are you going home? - There's a flight tonight at 9.
You're giving up awfully easily, aren't you? I was rather firmly discouraged from continuing to try.
You know what life is? Joy and grief, hand in hand.
You can't know real happiness until you've had sorrow to contrast it with.
She hasn't learned that yet.
Leave him alone, Mother.
We were just catching up.
- Rib spreader.
- Abby, get the suction.
I don't get it.
Stab is in the neck.
Yeah.
The knife must have angled down, bagged the subclavian.
Stand back.
This is gonna be pretty bloody.
- Dry as a bone.
- Starting internal compressions.
- We put in six units.
Where's it all going? - Hold compressions.
- Fine V-fib.
Internal paddles.
- Oh, man.
Son of a bitch.
All right, stop bagging.
Eighteen-gauge needle.
- Coronary artery's full of air.
- An air embolus? All right.
That's it.
We're done.
Time of death, 11:47.
How did she get that much air in her heart? I don't know.
She had an open neck wound.
The negative pressure sucked air into her jugular.
I don't see how that's possible.
She has an occlusive dressing.
I I took it down to explore the neck.
Was it before or after the intubation? This was before.
You took down a patient's dressing before she was intubated? Excuse me.
Dr.
Lockhart? Your emphysema guy is coding.
But it was only for a few breaths.
I didn't Damn right, we're gonna stay closed as long as I've got crap- I don't mean figuratively.
- literal crap pouring out of my ceiling.
- I came to check his neb.
He was down.
- Mr.
Brixton? Mr.
Brixton? - PVCs.
- All right, a mac-two and an 8.
0.
You should have got me if he was tiring out.
- No, no.
He was holding his own.
- Systolic's 77.
- Okay.
NS, wide open.
Start second line.
- Run of six.
- All right.
What now? - Acute emphysema flare.
He went apneic on continuous nebs.
- V-tach.
- No pulse.
Start compressions and mark the time.
Let's get an ABG and a capnograph now.
- How's she doing? - Good sats, no stridor.
Got a repeat EKG and neck films.
You're doing good, Rebecca.
I didn't mean to hurt her.
I just wanted her to leave Rebecca alone.
Did she suffer? No.
We put her to sleep to work on her.
She didn't suffer any pain.
I didn't mean to kill her.
We loved her.
Two hundred.
Clear.
- Back in sinus.
Got a pulse.
- Okay.
What do you got? Emphysema flare.
Abby had him on continuous albuterol.
He was wheezing.
Given the acute setting- Chuny, correlate the capnograph to the ABG.
Set the rate at 40.
- Abby, what's the end tidal CO2? - Ninety-six.
Can you tell me why? - He was apneic.
- Why? - He wasn't ventilating? - That's not an answer.
- He has emphysema? - Wrong.
- Tired out.
- No.
- Basic respiratory physiology.
- He was hypoxic.
- ABG's back, pH 7.
1.
- Think about it.
Emphysemics chronically retain CO2.
- They rely on relative hypoxia- - To trigger their respiratory drive.
I put him on nebs, oxygen, and took away his impulse to breathe.
- Leading to hypercapnia, acidosis, V-tach.
- Yeah.
- Sorry.
- Don't apologize to us.
He'll be okay once you blow off some CO2.
It's a classic intern mistake.
You won't make it again.
Get up.
Get up.
- What? What's going on? - Tell them.
That poor woman in there thinks she murdered her own niece.
Now, Ray.
Hey.
If it's any consolation, that was a great teaching case for me.
I'm glad my public humiliation can further your educational goals.
The guy is fine, Abby.
It's not your fault he smoked two packs a day for decades.
So I was thinking that I might rank County as my first choice for internship.
What about UCSF? I don't want to go to UCSF.
I want to stay right here.
Don't do that for me.
Now, this was a seriously crappy day.
Who wants to get drunk and pick a bar fight with a bunch of law clerks, huh? I still have an hour of charting to do.
How are Birdy and Rebecca? - They're gonna be fine.
- Did you find out what happened? Turns out the niece had them panhandling to support her crack habit hit them when they didn't bring home enough.
Well, well.
If it isn't the three amigos.
Let me see.
Failure to recall basic respiratory principles unsupervised umbilical lines in an infant and a fatal air embolus.
- Hey, when do the new interns start? - A week from Monday.
Man, oh, man.
God help your patients.
Wait up, dude.
I don't know about you, but I feel really inspired now.
So I think I'll go and throw myself under a train.
Don't go away mad, Jake.
But do go away.
I'm moving back to Africa.
And we can start over.
We can do everything that we didn't do before.
You take as much time as you need.
Take a month.
Take a year.
You can take 10 years.
I don't care.
And I'm not leaving without you, and I'm not living without you.
I love you.
I love you.
R.
Previously on E.
R.
- You won't tell me how you feel.
- Because it's fine.
If you're having trouble, see a therapist.
If you can't, work separate shifts.
This is our niece, Shelley.
I just found out they were here.
We're waiting on Social Services to come down here.
It was my father's.
I want you to have it.
It suits you.
E.
R.
11x21 "CARTER EST AMOUREUX" Surveying your kingdom? I was just wondering, what do they do with all the dirt? When is it supposed to open? A year from September.
Hey, congratulations, by the way.
Tenure.
Thank you.
What? That's not a good thing? No, it's good.
It's great.
So you got about two weeks left on your internship, huh? You ready to be an R2? Do I have a choice? Can't believe it went so fast.
I don't hear many interns say that.
Who's Joshua? - Family member.
- Yes, I got that from the "Carter" part.
Joshua's what Kem and I were gonna name the baby.
It's a good thing you're doing here, John.
If Surgery's mad some guy went up without a central line, they scream.
Gl's pissed some ulcerative colitis went home without follow-up - who do they yell at? - Me.
You got it.
You also have office hours for the med students and Residents to stop by if they have any problems or questions.
- I get an office? - Well, other chiefs haven't really used it.
Where is it? Morris, "office hours" is just a figure of speech.
Just make yourself available at Admit.
You're the new head cheerleader.
Organize parties, treats for Residents working holidays, host happy hours.
- Do I get a budget for that? - Yeah.
It's called your ATM card.
Next year's Resident contracts.
Sign them and have them in my box by the end of the week.
Dr.
Barnett, we need to find time to talk about yours.
- So you two work together? - Yeah.
In the ER at County.
I'm a nurse.
Luka's a doctor.
Must be challenging.
Can be.
Place is an insane asylum.
How long have you been together? About a year, on and off.
Mostly on.
Have you sought therapy before? No.
So, what brings you to me today? I don't think Luka and I should be together.
Another four of MS along with two of Versed? Was that a statement or a question? - Four of MS, two of Versed! - Want Ativan? - Oh, God! It hurts! - No.
It has too long a half-life for pre-op assessment.
- Calm down.
- What's all the ruckus? Mr.
Lillion was checking radiator leaks while his engine was running.
- I caught my hair in the damn belt! - Avulsed his whole scalp.
- Okay.
- Then he tried to pull his hair out of the moving fan with his hands.
Open fracture of third and fourth metacarpals.
- And extensor-tendon lacs.
- You want antibiotics? - A gram of Ancef IV piggyback.
- Anything else? A hundred of gentamicin.
Why gent? Because open fractures are susceptible to Gram-negative organisms.
Pratt.
Some guy out front says he's a friend of yours.
- What's his complaint? - Nothing he'll tell me.
- Says he knows you from high school.
- Go.
I got this.
- Darnell.
- Greg, how are you doing? - What's up, man? - My boy.
- Remember K.
J.
, right? - Yeah.
- What's up, little man? - Get up and say hello to Dr.
Pratt.
- Where's the love at? - Right? - Getting big.
- Tell me about it.
- What's up? - Somewhere we can talk? - Yeah, yeah, yeah.
- All right.
Be right back.
- I'm happy.
- No, you're not.
- I'm not.
- Nobody is happy all the time.
He's like a sphinx.
I never know what he's thinking.
We talk.
We don't talk.
I talk.
You sit there and smile.
Occasionally, you nod.
And then I get mad.
I'm always the one getting angry.
- I'm always the one yelling.
- You want me to get angry? Yeah.
That would be nice.
Could you break a dish or scream at the top of your lungs? Something.
That's what I'm talking about.
What are you feeling, Luka? I'm happy.
I'm happy and Sam's not.
I don't know why.
We're healthy.
We enjoy each other, our work.
We have a good life.
How does that make you feel, Sam? Like hitting him over the head with a hammer.
Was there a particular event or series of events that led to your decision to come here today? Yeah.
I thought that I might be pregnant.
- And are you? - No.
Thank God.
- That's a pretty unequivocal answer.
- Yeah.
It's how I feel about it.
Is that how you feel about it, Luka? What is that? Hey! What the hell is that? What's what, Billy? That up there coming out of the damn ceiling.
It smells like crap.
- It is crap.
- Okay.
Bad enough I'm stuck in here, you gotta let the building crap on me? I think it's just your DTs kicking in, Mr.
Seiger.
Hey! Hey! Unless they're passing out ponchos better get him back in the ambulance and over to Mercy, pronto! - Jake's in Philadelphia? - Tulane.
- He was in San Francisco.
- Couple weeks ago.
Something disgusting is leaking out of the ceiling.
Call Maintenance.
That or a HAZMAT unit.
So Carter gets tenure and Dr.
Lewis doesn't? - Yeah.
- How do you explain that? Lewis has more seniority.
She runs ER.
Bada-bing.
Show me the green.
Hey, anybody seen Carter? He's got African love on the overseas line again.
He took the avulsed scalp.
Sorry, Kem.
Can I take a message? So you get tenure based on how much money you have? He's building a wing for the hospital.
She's pushing paper and banana bags.
Highly-qualified woman, well-liked man.
Who do you think? Oh, put your bra back on, Gloria Steinem.
Carter's been here 10 years.
Lewis split and then came back.
It's a level playing field now.
Haven't you heard? Ix-nay on the Lewis-nay.
Dr.
Barnett, do you have a minute for me? Sure.
- So, what? He interested in medicine? - No.
But he's got to do his community-service hours somewhere.
- What did he get busted for? - Tagging.
Had some weed on him too.
Hey, we did a lot worse, just never got caught.
Yeah, speak for yourself.
It ain't my fault I ran faster.
All right, look, on the real I'm just a hired hand around here.
It's not really my decision to make.
But you'll ask? - Yeah, man.
- My man.
- I'll ask.
- My man, 50 grand.
Because I don't think it would be fair to Alex.
Alex is? My son.
He doesn't have enough problems without feeling he's getting elbowed by a baby.
I think Alex would like a brother or a sister.
A family.
- He has a family.
- Okay, hang on.
Hang on.
Time-out.
Luka, issues revolving around having children can be complicated when one person in the relationship already has a child.
God, Luka.
I didn't wanna have a kid the first time.
Alex was unplanned? Yeah, you could say that.
- I was 15.
- Well, you're not 15 anymore.
After what happened to your wife and kids you really want to bring another baby into this world? You had a family before? He says he's happy, and he can't even talk about it.
I had two children and a wife.
They were killed years ago.
How does it help us for me to talk about these things? It's a huge part of who you are, and you won't let me in.
How come every kid named Destiny, Miracle or Faith ends up with leukemia? Alkalinize her fluids and give Oncology a heads-up.
That scalp guy went to the O.
R.
Oh, you got another call from your Kenyan love nest.
It's the Congo, Frank.
And I know that you know it's the Congo.
Kenya, Congo.
It's all mosquitoes the size of flying toasters to me.
She sounded kind of upset.
You're all set.
Gonna leave that bucket in the middle of the floor? Shut off the toilet in O.
R.
Soon as it drains, we'll snake it.
So how long we gonna have raw sewage seeping out? Another hour or two at the most.
Okay, great.
So when the bucket's full just toss it into the street like we do chamber pots.
Kem Likasu, please.
Is this Charles? Hey, Charles.
It's John Carter.
Good, good.
Is she around? I found the Chief Resident's office, but there's boxes I need you to move.
- She what? - I look like Beakins to you? Get a couple of your interns, lean on them.
- See, but they're busy and you're not.
- What happened? Ray, honestly, what are you doing here? This is a great program.
You were lucky to get into it.
- And you're just taking up space.
- You don't think I'm a good doctor? I think you could be a very good doctor, but you know what? You watch the clock all day just waiting to punch out.
You have two weeks left on your internship.
Take your degree and go work at a doc-in-a-box or do air transport.
If you're doing this to make a living, you don't need a specialty.
You make more than enough money right now to support your music.
Don't sign this contract unless you are sure this is what you want to do.
Did something happen to Kem? No.
It's her mother.
She's in the hospital.
- In Africa? - No.
Her mother lives in Paris.
- Did she say what happened? - Didn't talk to her.
She'd already left for the airport.
Hey, Frank.
I don't know where Susan is.
- Would you please tell her I had to go? - Go where? Just tell her that I'll call her from O'Hare, okay? Gotta go by the bank on the way back if that's okay.
Do you need anything from Home Depot? - I thought I'd swing by before work.
- Home Depot? Yeah.
I need to get some anchors to fix that towel bar Alex pulled down.
- Where are you going? - Leave me alone, Luka.
Are you gonna walk? It's gotta be five miles.
Towel bars? Sam! - What's he doing in Paris? - Kem's mother is sick.
Meningitis.
She's immunosuppressed from chemotherapy.
With Carter AWOL, you and me pick up the slack.
Five night shifts in a row? - What? - The new schedule.
Morris? If that's what it says.
A swing shift and a day shift back-to-back? - And Ray gets every weekend off.
- What? - Cubbies-Braves, right? - Got you covered.
- All right.
- Oh, I see.
- So he bribed you for a good schedule.
- Of course not.
That would be unethical.
Oh, I hear U2 tickets are hard to get.
It's a shame.
I really wanted to go.
Dr.
Lewis? He is the chief.
Any way we can make Abby Chief Resident? Morris isn't the sharpest shovel in the shed.
But he's a paperwork hound.
Besides, keeps him from seeing patients.
Think of it as community service.
- CT call on Werntz yet? - I'll call them again.
- Flowers usually work.
- Hey, Jerry, I want you to meet K.
J.
- He's our new volunteer.
- Volunteen, welcome.
Jerry will be telling you what to do.
Jerry, just have him run specimens up to the lab or whatever.
- Specimens? - Yeah.
Blood, urine Piss? Nasal swabs, wound cultures, stool samples, the whole enchilada.
Hey, Pratt, 47's pulling in with a septic newborn.
Hey, you don't like it, the door's that way.
Stool sample is what I think it is? - Septic newborn? - So they say.
Hey, study your antibiotics last night? The gentamicin for the open fracture.
You should know this stuff cold by now.
Gonna be an R2 in a couple weeks supervising new interns.
- Gotta start stepping it up.
- Eight-day-old female, febrile to 104.
Grunting, severe retractions.
Can't get a pulse ox.
- Tachy to 192.
Resps, 80.
- Started this morning.
- I thought it was a cold.
- Access? I had a 23 gauge in the hand but it blew.
Fabienne Elmont? John? Hey.
What are you doing here? I got your message about your mom.
You should have told me you were coming.
Well, I called your cell.
No.
It doesn't work in Paris.
How's she doing? I can't tell what antibiotics they're giving her from the IV.
Oh, she's not on antibiotics.
They're not giving her antibiotics for meningitis? Viral meningitis? - Who told you she had meningitis? - I called the clinic.
Charles said you flew to Paris.
With all the chemo, I just assumed that - So she's okay? - She had a fever, the doctor got worried.
So he admitted her.
But she's much better now.
Good.
John, this is an old friend of mine, Michel Timbaud.
BP's 58/29.
- She needs volume.
- You're hurting her! Can't help unless we give her fluids, medicine.
I'm in.
Portable x-ray.
Call RT for a vent.
- Good chest rise.
- All right.
Airway and access.
Neela, what's your plan? Normal saline, CBC, blood culture, amp and cefotax.
- Good.
- Hodgkin guy's pressure - dropped after antibiotics.
- Run a liter.
- He's trying to pull out his broviac.
- Give the bolus.
I'll be back.
- Hundred cc's MS through the IO.
- Please tell me what's going on.
We suspect your daughter has an infection.
Giving her antibiotics.
Fluids elevate her blood pressure.
Tube is helping her breathe.
- IO's infiltrated.
Won't flush.
- How old is she again? - Eight days.
- Umbilical stump is still attached.
- Is that bad? - No.
That's That's good.
Umbilical-line kit.
Five French.
Sterile sixes and 10 blade.
Hey, Jerry, Hodgkin's guy needs a Med bed.
Let NICU know they got a customer.
Your volunteen kid doesn't seem very interested.
- Yeah.
Well, he's not.
- So why has he volunteered? - He has to work off his probation.
- What did he do? - Second-degree murder, I think.
- Really? He got caught tagging a police car.
- Wait.
He tried to spray-paint a cop car? - Yeah.
With the cop still in it.
- The kid's got guts.
- Either that or he's an idiot.
Small-bowel obstruction secondary to a popcorn overdose.
A 6-year-old ate a huge tub of popcorn all by himself.
- Yeah, and? - Call Surgery, get a CT.
Think they'll be ready to supervise interns in two weeks? Not a chance.
John.
That was awkward.
Where are you going? Back to the airport, I guess.
You just got here.
Well, you were right.
I should have called first.
Michel and I went to school together.
And he's fond of my mother.
- You two a couple? - We were.
Does he know about the past-tense part? Are you jealous? Yeah.
Hey, don't do that.
Don't laugh at me.
Okay.
Okay.
Are you sleeping together? No.
Do not answer that.
Well, you haven't been dating? Is there someplace around here I can catch a taxi to the airport? - Don't be so dramatic.
- Okay, look.
I'm sorry.
Okay? I'm tired.
And I shouldn't have just barged in on you.
And I feel completely ridiculous.
Actually, it was very sweet.
Yeah.
Okay.
Look, I'm really glad that your mom's okay.
Why don't you call me when you get home.
John.
Just stay.
Just for the night.
- Flushes easily.
- Hook up the transducer.
- Sats, 93.
Systolic's up to 78.
- Good.
That's good.
How we doing in here? - What are you doing? - Umbilical lines.
- You what? - Umbilical lines.
I heard you.
Why? - IO infiltrated.
We needed access.
- Why not just put in another IO? She still has an umbilical stump.
UAC and UVC allow for frequent blood draws.
Gases Did she do something wrong? Hotel La Pavillon.
I'll come by in the morning.
We'll have some breakfast.
Michel coming too? - He has to work.
- Those his real teeth? - They're a little too straight.
- Get some sleep.
- I'm gonna come and pick you up early.
- Yeah.
You get some sleep too.
You can't be placing umbilical lines by yourself.
Do you know the things could've gone wrong? Thromboembolism, vascular injuries, arrhythmias - I thought arterial monitoring- - You're an intern.
You can't play neonatologist whenever you feel like it.
I did a bunch of these - when we rotated through the- - Really? When, two years ago? Have you done one, even seen one since then? - You told me to take more initiative.
- Initiative? What about common sense, Neela? What's next, neurosurgery in the lounge? You need to know when to ask for help.
What the hell is this? What, you're gonna cry now? All right, look, you got lucky this time.
She's stabilizing.
But you have to start using your head.
Now go on.
Get out of here.
Go.
I'll deal with the NICU guy.
Hello? I'm sleeping.
It's dark outside.
All right, I'm up.
All right, I'm up, I'm up, I'm up.
How's Michel gonna get to work if we have his car? Who said it's his car? - Come on.
I wanna show you something.
- Does it involve coffee? Everything in Paris involves coffee.
Hurry.
We're gonna miss it.
- Where are we going? - Nowhere.
We're here.
You got me up at 5 in the morning to ride a train? Will you be patient for once in your life? She spent the night at her dying husband's bedside.
He was a member of the Resistance fought bravely against the Occupation while she smuggled messages for the Free French through Nazi lines on her bicycle.
He still loves her.
She's not so sure after all these years.
He is an accountant.
She is a waitress, longed to be a singer.
She had a mad, secret, tempestuous affair with her sister's fiancé.
What about them? It's a sad story.
She only has a few months to live.
Cancer.
They love each other desperately, spend every moment together.
What about us? You have a story for us? Quick.
Close your eyes.
Quickly, quickly, quickly.
Come on.
Close your eyes.
Wait, wait, wait.
Now.
What are you doing out here? Deciding if I'm sick.
Pratt's on.
- Hey, Neela.
- Hey.
Got you a bear claw.
They don't have the apple fritters.
- What are we doing? - Neela's trying to decide - if she should go to work.
- We get to decide? She put in umbilical lines in a newborn yesterday.
- Really? Cool.
- Unsupervised.
Pratt became unglued.
I miss all the good stuff.
Well, gotta go.
I'm gonna be late.
Gotta get back on that horse.
Nothing fancy.
Just primer and a couple coats.
- The lichen- - I'm not painting your office.
- Hospital does it.
Need a purchase order.
- Yeah, that comes out of my ER budget.
Hey, Pratt.
Stabbing victim in Trauma 1.
Back up the interns, please.
Paramedics are two minutes out with an MVA, a 9-year-old kid.
Okay.
Luka, can you get that? I've got an extubation in C2.
- We don't have to do the trim.
- No, Morris.
MVA coming in.
Trauma panel.
Type and cross for four.
- Pulse ox to 78.
- Taking down neck dressing.
- Shouldn't we tube her first? - Be my guest.
- Maybe there's something we can tie off.
- Etomidate and sux.
- Got the jugular, but spared the carotid.
- Can't breathe.
You're just going to sleep.
We breathe for you.
Prep for subclavian on the right.
-8.
0 ET tube.
- Is this the penetrating neck? Single stab wound.
Hypotensive, no sub-Q air.
- Two of O-neg on peripheral IV.
- Pressure's up to 90 palp.
- I'm in.
Bag her.
- Got a flash.
We'll have a central line for the next 2 units.
Good breath sounds.
Excellent.
Maybe there's hope for you two after all.
Professor Carter.
It's associate professor, actually.
Well, I'm proud of you.
- Susan didn't get tenure.
- Susan Lewis? Really? She's pretty pissed about it too.
She's not talking to me.
Now, this is what I really miss in Africa.
Baked goods.
What? - You have a lot of jam on your face.
- Well, help me.
Hello.
- Hey, hey, got a minute? - Not really.
What's up? I gotta finish my rankings for my match.
- I could use a little advice.
- Excuse me? There's something leaking from the ceiling.
Okay.
We're gonna move you right over here.
And Christian's gonna take care of you.
Thank you.
- Is that what I think it is? - Yup.
Susan, code brown dripping from the ceiling again.
Damn it, that is it.
Jerry, call the AOD.
Tell them we are closed to trauma until someone comes down and deals with the raw sewage leaking from the ceiling.
Is this the respiratory distress? - Jerry, what's open? - There's a bed in Curtain 3.
Arnold Brixton, 65, short of breath.
Sats, 83 on room air, Tachy at 115, afebrile, good BP.
On theophylline for emphysema.
- Don't say it.
- Say what? I stopped smoking five years ago.
- Good for you.
- Come on.
So I was thinking I might rank County as my first choice.
You want to stay in Chicago? Yeah.
I mean, my friends are here, all my family.
He needs a monitor and continuous albuterol with 500 of Atrovent.
What about San Francisco? UCSF has a great program, but County has a lot to offer too.
Those sisters are back.
Okay, 60 of pred and a portable chest.
- And do you wanna talk about this later? - Sure.
- Rebecca? Birdy? You okay? - You know them? They've been in a couple times before.
Circumferential ecchymosis.
Neela wants to get a telemetry bed.
What happened? Rebecca almost got strangled to death.
I tried to tell you guys it's too dangerous for you to be out there on the streets.
I'd be dead if Birdy hadn't stabbed her.
You stabbed the attacker? Well, I had to.
Is she gonna be all right? Yeah.
I mean, she seems stable for now.
- We might have to - No.
Not Rebecca.
Shelley.
Our niece.
They're working on her in that room over there.
I grew up playing here, when we weren't in Kinshasa with my dad.
My mom would save the old bread so I could feed the ducks on the weekends.
There was thousands of them in the summer.
Sounds idyllic.
Yeah.
Yeah, it was.
So why did you leave? It was different when I was little.
We were a novelty then.
My very white mother, my black father, with their little brown girl.
It wasn't easy for them.
You know that Joshua would be a year old now? I'm gonna head back to the hospital, see my mother, okay? What are we doing? What are we doing? I still love you, and I know you still love me.
We talk to each other every day.
We talk for hours on the phone.
We tell each other absolutely everything about our lives.
I make you happy.
I make you laugh.
I tried living in Chicago and it wasn't for me.
- We don't have to live in Chicago.
- You have your life there - your career, everything.
- I would give it up for you.
I don't want you to.
Kem, we had a baby and he died.
It's a tragedy that happens to people and it happened to us.
But that doesn't have to define us.
It doesn't.
We're stronger than that.
Aren't we? - I can't- - We can have another baby.
Stop this.
Stop doing this.
I'm sorry.
I'm sorry.
Are you gonna come to the hospital? Because Fabienne's gonna want to say goodbye.
Tidal volume's 700.
AC 14 on 100 percent.
- Units three and four on board.
- Did you follow up with Social Services - on home visit for the Chadwicks? - I'm Who? The two old ladies that panhandle on the south.
You sent them home with their niece.
- From a few weeks ago? - Yeah.
- Down 60 systolic.
- Check for tracheal shift.
Get four of type specific.
This is the niece, Shelley.
Birdy stabbed Shelley.
- She was trying to strangle Rebecca.
- She what? You sent them home with Shelley.
Did you forget about the follow-up - or not want to deal with it? - I called.
But what do I do? - Make sure they do their job? - People - can we focus on the patient? - V-fib.
Starting compressions.
- Ambu-bag.
- Charge at 200.
- Cardiac history? - I don't know, Ray.
You're the only one that's met her.
Clear.
Oh, we're being rude.
No.
I'm hungry.
Will you get me something, mon ange? Thank you for the beautiful flowers.
He's a very handsome young man.
- Who? - Michel.
Well, yeah, I guess.
Also something of a fool.
- When are you going home? - There's a flight tonight at 9.
You're giving up awfully easily, aren't you? I was rather firmly discouraged from continuing to try.
You know what life is? Joy and grief, hand in hand.
You can't know real happiness until you've had sorrow to contrast it with.
She hasn't learned that yet.
Leave him alone, Mother.
We were just catching up.
- Rib spreader.
- Abby, get the suction.
I don't get it.
Stab is in the neck.
Yeah.
The knife must have angled down, bagged the subclavian.
Stand back.
This is gonna be pretty bloody.
- Dry as a bone.
- Starting internal compressions.
- We put in six units.
Where's it all going? - Hold compressions.
- Fine V-fib.
Internal paddles.
- Oh, man.
Son of a bitch.
All right, stop bagging.
Eighteen-gauge needle.
- Coronary artery's full of air.
- An air embolus? All right.
That's it.
We're done.
Time of death, 11:47.
How did she get that much air in her heart? I don't know.
She had an open neck wound.
The negative pressure sucked air into her jugular.
I don't see how that's possible.
She has an occlusive dressing.
I I took it down to explore the neck.
Was it before or after the intubation? This was before.
You took down a patient's dressing before she was intubated? Excuse me.
Dr.
Lockhart? Your emphysema guy is coding.
But it was only for a few breaths.
I didn't Damn right, we're gonna stay closed as long as I've got crap- I don't mean figuratively.
- literal crap pouring out of my ceiling.
- I came to check his neb.
He was down.
- Mr.
Brixton? Mr.
Brixton? - PVCs.
- All right, a mac-two and an 8.
0.
You should have got me if he was tiring out.
- No, no.
He was holding his own.
- Systolic's 77.
- Okay.
NS, wide open.
Start second line.
- Run of six.
- All right.
What now? - Acute emphysema flare.
He went apneic on continuous nebs.
- V-tach.
- No pulse.
Start compressions and mark the time.
Let's get an ABG and a capnograph now.
- How's she doing? - Good sats, no stridor.
Got a repeat EKG and neck films.
You're doing good, Rebecca.
I didn't mean to hurt her.
I just wanted her to leave Rebecca alone.
Did she suffer? No.
We put her to sleep to work on her.
She didn't suffer any pain.
I didn't mean to kill her.
We loved her.
Two hundred.
Clear.
- Back in sinus.
Got a pulse.
- Okay.
What do you got? Emphysema flare.
Abby had him on continuous albuterol.
He was wheezing.
Given the acute setting- Chuny, correlate the capnograph to the ABG.
Set the rate at 40.
- Abby, what's the end tidal CO2? - Ninety-six.
Can you tell me why? - He was apneic.
- Why? - He wasn't ventilating? - That's not an answer.
- He has emphysema? - Wrong.
- Tired out.
- No.
- Basic respiratory physiology.
- He was hypoxic.
- ABG's back, pH 7.
1.
- Think about it.
Emphysemics chronically retain CO2.
- They rely on relative hypoxia- - To trigger their respiratory drive.
I put him on nebs, oxygen, and took away his impulse to breathe.
- Leading to hypercapnia, acidosis, V-tach.
- Yeah.
- Sorry.
- Don't apologize to us.
He'll be okay once you blow off some CO2.
It's a classic intern mistake.
You won't make it again.
Get up.
Get up.
- What? What's going on? - Tell them.
That poor woman in there thinks she murdered her own niece.
Now, Ray.
Hey.
If it's any consolation, that was a great teaching case for me.
I'm glad my public humiliation can further your educational goals.
The guy is fine, Abby.
It's not your fault he smoked two packs a day for decades.
So I was thinking that I might rank County as my first choice for internship.
What about UCSF? I don't want to go to UCSF.
I want to stay right here.
Don't do that for me.
Now, this was a seriously crappy day.
Who wants to get drunk and pick a bar fight with a bunch of law clerks, huh? I still have an hour of charting to do.
How are Birdy and Rebecca? - They're gonna be fine.
- Did you find out what happened? Turns out the niece had them panhandling to support her crack habit hit them when they didn't bring home enough.
Well, well.
If it isn't the three amigos.
Let me see.
Failure to recall basic respiratory principles unsupervised umbilical lines in an infant and a fatal air embolus.
- Hey, when do the new interns start? - A week from Monday.
Man, oh, man.
God help your patients.
Wait up, dude.
I don't know about you, but I feel really inspired now.
So I think I'll go and throw myself under a train.
Don't go away mad, Jake.
But do go away.
I'm moving back to Africa.
And we can start over.
We can do everything that we didn't do before.
You take as much time as you need.
Take a month.
Take a year.
You can take 10 years.
I don't care.
And I'm not leaving without you, and I'm not living without you.
I love you.
I love you.