ER s13e03 Episode Script
Somebody to Love
KOVAC: Resident in-service exam is Friday.
Practice questions and instructions are in the packet.
Shouldn't we learn something before you start testing us? It's to get a baseline.
We'll re-test you at the end of the year.
Um, is there a makeup date? Friday's my day off.
I volunteer at Big Sister/Little Sister.
Yeah, well, I'm post-call, which means I volunteer to sleep all day.
Well, too bad.
Conference room, 8 a.
m.
KOVAC: Come on, guys.
PRATT: Who else is on? Weaver is on at 12.
Until then, you're in charge.
- What about Morris? - He just called.
He's running late, he said start without him.
For his first shift as an Attending? Did he say why? I couldn't understand him.
It was windy and the music was loud.
MARQUEZ: Ma'am.
- Windy? [JOEY SCARBURY'S "BELIEVE IT OR NOT" PLAYS ON RADIO.]
[SINGS " BELIEVE IT OR NOT".]
Rat-bite kid is in Bed C.
Waiting on a shot of penicillin and a piece of pizza.
- Oh, the surgeon is in.
- I think I left my badge here.
- Are you nervous? - No, I'm okay.
- Happy rounding.
- First day, don't let them haze you.
WOMAN: The sidewalk was crooked.
I wanna talk to Johnnie.
You're gonna have to call them back later.
Look, J.
Lo, I got 10 minutes left on my card and I ain't signing until I talk to my attorney.
Don't tell me Johnnie Cochran's dead.
MARQUEZ: Give me a break.
- Let me help.
- It's not heavy.
- They found some bad wiring.
The whole place is like a tinderbox.
Really? Got a light? James Anderson, shortness of breath, history of heart failure.
Gave nitro spray and 40 of Lasix.
The guy's a chronic CHF'er.
Forty won't do the trick, he needs 80.
Protocol says 40.
Not that I'd expect you to know or give a damn.
Picked him up in the hall of his apartment.
Place had some wild stuff.
- Feather boas, stiletto heels.
- One, two, three.
GATES: Sounds like your locker.
What meds is he on? It's on the paramedic sheet, which is also part of Protocol, right.
I smell a theme.
SAM: Eighty of Lasix.
- Unh.
- Sats suck.
GATES: Must have a bad lead.
He does.
Look at this, it's on his chest hair.
Is that part of the? What do you call it, protocol? Isordil, Bumex, glyburide.
- Benzoin for the chest lead.
NURSE: Here you go.
GATES: All right.
Protonix, Diovan and carvedilol.
Let me help you.
- All right, sats are up.
- Lasix in.
Hey, can you look at me? - It's good.
- Saved your ass again, Zades.
Hey, where's that famous sense of humor of yours? You know, it was bad enough before.
Now I gotta roll in, have you play me because somebody gave you a white coat? - What are you so pissed off about? - I'm on probation for a month.
Limited shifts, no extra runs, and one wrong move, I'm finished.
What? Those two drunk guys outside of Ike's press charges? No, the bar manager filed a complaint, so chief's gotta make sure I feel it.
- I didn't hear anything about it.
- Well, of course not, you're Mr.
Teflon.
- Only now it's Dr.
Teflon.
- It's no big deal.
- What's probation, a month? - It's my job, man.
My job.
You know, the one good thing about you working here: You may just have to listen to somebody besides yourself once in a while.
And I can't wait to see those sparks fly.
I'll catch you later, killer.
[BUZZES.]
Well, he didn't mean " killer" killer.
He meant You know All right, back to work, everyone.
Barack.
Barack Obama.
Don't waste my time, put him on.
[CRASHING.]
[CLASSICAL MUSIC PLAYING ON PIANO.]
[CHATTERING.]
[KNOCKS ON DOOR.]
MAN: Benny, your neighbor's on the phone.
Something about Jim.
[CHATTERING.]
Excuse me.
Triage desk.
Uh, no, I'm here for someone, James Anderson.
They brought him in an hour ago, I think.
Triage desk.
Thank you.
[SIREN WAILS.]
- Hello, l - Fill out this form, sir.
I'm here to see a patient.
Oh, okay.
Then try this one.
[BABY CRIES.]
[LIGHT SPARKS.]
Easy, now.
We got enough patients already.
Charity, I got one for you.
I'm Hope, my name is Hope.
Right, 8-year-old girl fell off her bike.
Oh, poor little angel.
PRATT: Hey, think fast.
- Whoa.
What's this? - It's your lucky day.
Residents get to wear the new transport beeper.
If this thing goes off, I can sign out my patients and go, right? Well, if your Attending, i.
e.
Me, agrees that the patient is critical and needs a physician transport, then, yes, Ray, you may go.
Sweet, I'm gonna go check the transpo locker.
- Is Dr.
Kovac around? - Hey, how you doing? I think Dr.
K ran upstairs but I'm pretty sure I can help you with anything you need.
You represent this hospital and that's how you approach people asking for help? KOVAC: Angela? I was waiting for you upstairs.
I'm sorry, my train was late.
But I had the lovely opportunity to meet " Dr.
Pratt.
" Impressive.
- Got a minute? - Yeah, sure.
[MOUTHING.]
What? Haleh, what the hell just happened? I think you got served.
- Greg Pratt, Timmy Rawlins.
- Hey.
- He's gonna be filling in for Jerry.
PRATT: Really? In fact, he was Jerry before Jerry was Jerry.
PRATT: Wow.
Yeah, back in the mid-'90s.
Got stuck in a rut.
I had to get out.
- Out of the hospital? - No, out of Chicago.
I lived in the Kalahari for a while, selling biltong outside of Kakamas.
Then I spent a couple years mining uranium in the Siberian tundra.
Ran into a misunderstanding in Thailand, that landed me in the Bangkwang prison.
- But most of the '90s is still a blur.
PRATT: Wow, sounds rugged.
Hell, I'd take Bangkwang over ER this time of year.
As you know, them new interns will mess you up worse than Chinese hash.
Ain't that the truth? [MACHINE TOOLS BUZZING.]
It's about the Curtis Ames case.
Risk Management wants to meet tomorrow at 9 a.
m.
Curtis Ames? Left-sided paralysis following an embolic stroke.
You placed a central line for pneumonia and he boarded down here for three days.
February of '04? Oh, oh, oh.
But I thought the case had no merit.
Ha.
Guy wants his day in court.
But the lawyer said - It's been a year since my deposition.
TIMMY: Excuse me.
- Angela from Staff Affairs? - Ms.
Gilliam.
Ms.
Gilliam, Dr.
Tremons on the phone, he says his privileges have been Tell him the Anesthesia chair has to keep his ACLS current just like every other physician in this hospital.
Okay.
I got you, baby.
Look, malpractice suits are a waste of time and resources but it happens to almost every doctor at some point.
It doesn't reflect on your abilities as a physician.
See you tomorrow.
Ultrasound confirmed cholecystitis.
Hang a bag of ertapenem, send her to surgery.
I'll give the nursing report.
Scaphoid fracture, thumb spica in Bed A.
- Discharge with clinic referral.
- No problem.
This one over here? Curling iron, upper inner thigh.
Dressing and tetanus, and, uh, send her on her way.
- How do you even know that? - Don't ask, don't tell.
Pratt, sign Gates up for some more.
- The man knows how to clear a bed.
- Really? Why do I have patients with blank charts and I haven't heard about your CHF guy? - He's stable.
We're waiting on labs.
- His sats are 91.
He's hypoxic.
- That was before oxygen and Lasix.
- What's the EKG show? Nothing to worry about.
This gentleman's here for James Anderson.
- You family? - We're business partners.
My name's Cray.
Bennett Cray.
All right.
Dr.
Gates can take you in.
- But keep me apprised.
- All right.
We're waiting on some test results but, uh, we could use information on his medical status.
Yes, I can help with that.
I brought in his meds.
Your, uh, mascara's running.
Oh.
It was a long night.
You round twice a day, In between, you'll cover floor patients and consults.
And hopefully scrub in on a few cases? Sure.
Neela, this is Jill Connelly and Ken Maser, your fellow interns.
And this is Dr.
Crenshaw.
CRENSHAW: Sweet urine of a hairless eunuch.
DUBENKO: Dustin? CRENSHAW: No, I don't think so.
What I asked for was a freaking ginger ale.
DUBENKO: Dustin? Dustin? Dr.
Crenshaw is our new Chief Resident.
Neela Rasgotra.
Put in two years in the ER, then defected to become a real doctor.
Wow, it took you that long to figure out you were wasting your time? - Oh, I don't think of it that way.
- Really? And why is that? I developed clinical and procedural skills.
[YAWNS.]
I became proficient at ultrasounds, central lines, chest tubes, cutdowns.
Wow, you know what worries me? Maybe all of this is gonna seem too easy.
You think? Think there's a chance you might be Oh, I don't know.
What's the word, um bored by what we do up here? - I don't think so.
- Good.
Good.
Then I think I'll leave you all to it.
Bye.
CRENSHAW: Someone want to explain to our international prodigy here how we do wound rounds? [MONITOR BEEPING.]
Mr.
Cray.
BENNETT: Doctor.
His oxygen level is up.
He should be waking soon.
Is there any family he'd like here? Uh, just me.
That's all.
Just the two of us.
We each come from a long line of homophobes and bigots.
The closet reflex dies hard.
- How long have you two been together? - It's been over 15 years now.
We found each other late.
He thought no one'd ever love him, and I'd already resigned myself to being a Ionely old drag queen.
In the right light, he looks like Barbara Stanwyck in The Lady Eve.
Ha.
To you, maybe.
Now I look more like Mrs.
Doubtfire.
I'll let you two talk, and, uh, I'll be back as soon as I know anything, okay? Hey, Luka, can you sign a wrist x-ray order for the Obama lady? Sure.
I hear the baby's doing well.
- He's starting to hold his head up.
- Oh, that's great.
We never got to talk about everything that happened.
It's not your fault, Sam.
If it wasn't for me If it wasn't for you, I'd be dead.
How is everything? It's good.
You know, pretty good.
I, uh Alex is seeing this shrink lady, but he's not really into it.
- He likes to keep everything bottled up.
- I meant with you.
I'm fine.
Really.
[SIREN BLARING.]
You want me to try talking to Alex? No, you've got enough on your plate, uh but thank you.
- Sam, hey.
Just don't beat yourself up.
You did what you had to do.
It was self-defense.
HOPE: Born in a poor village in central Guatemala Soledad Guttierrez is an immigrant who works cleaning houses.
She's had a hard time adjusting to life in the U.
S.
Wow, you really bonded with her.
Felicity, hurry up and get to the point, will you? Soledad is worried every day and prays all the time for her husband and 4-year-old son back in their hometown of " Chichicastenango.
" Oh, sure, I got down to Chichi for el DÃa de los Muertos back in '96.
She's thorough, there's no denying that.
- But she's getting older and might not PRATT: Look, look, look.
I don't need her whole life story.
Why is she in the ER today? Well, she had a great uncle who died of a heart attack.
His wife and children were left without anyone so they had to move in with her parents All right, stop, stop, stop.
What brought her to the ER? Her heart.
It's her heart.
Good, so do you think it's an MI? Pericarditis? Dysrhythmia? Well, she's been unable to find a suitable church so I believe that she feels so alone in this world that her heart is aching for her family and her homeland.
Okay, okay, well, diagnostically, what you just said is nothing.
SAM: Need a hand here.
- Group home resident, 22 years old.
MAN: Release me, you merchants of destruction! - You need to stay in bed.
- Morris.
Good to see you.
Glad you could make it.
Oh, the pleasure's all mine.
The home thinks he might have ingested something.
All right, 10 of Haldol, 2 of Ativan I.
M.
Oh, this is Rodney King all over again.
- Hey, no pictures in here.
- You ain't fooling nobody.
- Harriet, get back to your bed.
- Obama gonna see this.
[LAUGHING.]
How you feeling, Mr.
Anderson? Oh, better.
Tell him he can go.
He's got a show tonight.
We're having a fundraiser for the Chicago HIV/ AIDS Coalition.
And I don't want you missing it on account of me.
He never misses a show.
Fine.
Listen, we have some test results.
Good news is you did not have a heart attack.
- Oh, thank God.
- But you're not making urine which means your kidneys aren't working, so you'll have to go on dialysis.
- I don't think so.
- Jim.
- It's pretty urgent.
- I've been to enough doctors already.
Had enough tubes and machines and treatments.
- No, I'm not gonna do it, don't ask me.
BENNETT: It's okay, Jim.
It's okay.
So, what else can we try? What are his other options? His options? Well, dying.
Very soon.
[MONITOR BEEPING.]
No, it's enough already.
Jim, there's no choice.
Dialysis can substantially prolong your life.
I already got the bad heart.
I'm sick of being sick.
I'm not gonna be some broken-down cripple.
You're tired, I know that.
- But remember what we always said? - It's enough.
- Choose more life.
- Whatever's gonna happen.
- No matter what, remember? More life.
- I don't wanna do this to you.
You promised.
Okay.
Okay.
But you gotta do something for me.
Call Lorraine and tell her what's going on.
- Jim.
- Call her.
Just tell her to bring the boy.
I wanna see him.
It's not a good idea.
Don't get into it all.
Don't try to explain it.
Just tell her I wanna see them.
It's been too long.
Please, Benny.
You got to do it.
All right.
His sister and her son.
I've never met them.
So dialysis? Yeah, let's get him up as soon as we can.
I'll make the call.
Hmm.
He was already 50 by the time he figured it out.
He wanted to tell his family, but they shut him down.
So he just left.
Disappeared one day.
Found me.
No openings now, but I told them we could start him down here.
His serum K level is still high.
All right, amp of bicarb, 25 grams of D50, 10 units of regular insulin.
- May I use that phone? - Sure.
There's one down the hall if you want privacy.
Thank you.
Oh, excuse me.
Gates, Rheumatology came down on the polymyositis patient.
- No H and P on the chart.
- Didn't get to it yet.
No, that's not good enough.
Sam, you got this? - You come with me.
GATES: All right.
Give me an ETA on the dialysis.
I got enough problems without you pissing off other departments by not keeping current on your charts.
- Trying to use my time well.
- Not enough.
Get that up-to-date.
- Thank God, someone who understands.
- Rough morning, Greg? I'm glad to have you.
Will you come check my vertical mattress? I think I everted the edges too much.
- Not until he listens to my bronchiolytic.
- Did you try a neb? Don't worry, I'll show you.
I'm with Dr.
Pratt today.
Okay.
I need to present my barbell-on-the-toe guy.
I can help you with that.
Hey, guys, this is the esteemed Dr.
Weaver in the house, okay? So take advantage.
Present to her.
Soak up all her decades of experience.
Decades? What am I, a fossil? All right, go run and hide.
We'll be there in a minute.
You know what? I'm fine.
I'll push charts, help clear some beds.
- I hope this isn't awkward.
- What? - That you and I are equals now? - I guess.
Hector Rodriguez, 38.
Found on the sidewalk.
Hey, there's Tony.
Tony, man.
- Cue Ball, what are you doing here? - Some misunderstanding.
- History of ETOH.
- We know.
- Did you vomit any blood? - Not this time.
I was just sleeping and some skank called 911.
Where do you want him? - Did you fall? - Oh, no, no.
That's old.
- A junkie rolled me weeks ago.
- Yeah, occupational hazard.
Hope, get this dude to Exam 3.
- I got him.
I know him.
- Look for signs of occult trauma.
- Yes, sir, Dr.
Pratt.
- I can get him.
You finish that.
Is that the bleeding heart of Jesus? Sure is.
Isn't God great? You ain't so bad yourself, honey.
There were no open spots upstairs, so we're starting him on dialysis here.
Is that Uncle Jimmy in there? Hello, uh, Lorraine? You're the man I talked to on the phone? Bennett Cray.
My brother, Harold, and my son, Brian.
James asked you to call us? He wanted to see his family.
Now? Like this? It's par for the course, I guess.
TECHNICIAN: He's having ectopy.
Runs of six.
Damn it.
Get Gates and Pratt in here.
His K's going up again.
Ejection fraction is 10 percent.
What does that mean? It means his heart's not pumping well enough.
SAM: He have an advanced directive? - You mean like a DNR? No, I talked to the other doctor about this.
Well, why are you asking about a DNR? We need to know how far he'd want us to go.
- Whatever you can.
- We knew he was sick I talked to him, he said he was having problems with his diabetes and some trouble with his congestive something.
He called you? Yeah, in June, when I graduated.
What are his chances? Well, it's possible if we put him on dialysis, avert a cardiac incident Can he take all that? He's very resilient.
- He's been through a lot.
HAROLD: He's been sick for years.
He's not the type to wanna be kept alive on machines.
Well, your brother and I have discussed these matters.
We need a few minutes to figure this out.
- Sure.
- Maybe I can be of some help.
Jim and I are good friends.
We've been together for quite a while now.
Thank you, this is a family matter.
We appreciate all you've done.
We'd like some privacy now.
Oh, yes, all right, I'll just step outside.
SAM: QRS complex is widening.
TECHNICIAN: Ready to start the run.
PRATT: Wait a minute.
Hold on.
Sam? Where's Gates, and why is this chart blank? He goes fast.
He probably fills out the paperwork later.
- You got this guy's meds in your notes? - Yeah.
[SIGHS.]
Okay.
Amp of calcium chloride.
TECHNICIAN: We doing this? - Yeah, in a minute.
Let me give him calcium to stabilize his heart.
Once we do, we'll figure out what's next.
Okay.
WEAVER: Hey, Haleh? Pass me a head sheet and Vicodin? Get him started on something for the pain.
Sorry, we got rid of head sheets about a year ago and we're not allowed to dispense meds from the ER anymore.
What's a patient supposed to do if they can't get to a pharmacy? You are preaching to the choir, sister.
I liked it better when you ran the joint.
PRATT: Charged.
Clear.
Still V-fib.
Resuming compressions.
- What happened? PRATT: Amp of epi.
Why isn't he dialyzed? QRS widened.
Gave him calcium, and now he's crashing.
Is my uncle dying? [WATCH BEEPING.]
What's that alarm? It's his meds.
He gets afternoon doses of glyburide, Lasix and didge.
What? - Did you say didge? - Digoxin, 0.
25 milligrams.
It's right here.
Can everybody step back for a minute while we work on him, please? Charge to 360 again.
LORRAINE: You help my brother with his medication? BENNETT: Sometimes, yes.
No one said didge.
You showed me Diovan.
- That's what I was told.
- By who, the paramedic? What does Zadro's sheet say? Digoxin.
- You didn't look at his med bottles? - We didn't have them yet.
He has high levels of intracellular calcium from the didge and I pushed more, enough to stop his heart.
Why? Because you couldn't slow down enough to read the med sheet right.
BENNETT: Can you tell me what's going on? [SIGHS.]
The drugs we gave him to treat his QRS has irritated his heart.
[PADDLES CHARGING.]
Clear.
Clear.
No change.
Uh, so, what now? What else can we do? Hey, what about Digibind? Depends on his DNR status.
Have you all come to a decision? We've decided it's enough now.
It's time to let him go.
- What? No.
- Our brother's an old man.
- He's been sick for a long time.
- No.
- He wants to fight.
- He's got no one.
He has friends.
A support system.
And who's gonna take care of him? - You? - I always have.
We're his blood.
We don't think he'd wanna suffer through all this.
You don't know that.
You don't know him.
- But I do.
- And that was his choice, not ours.
I love him.
I love him.
I asked you once politely to go.
You have no part in this.
We can treat your brother with Digibind.
It'll give him a fighting chance.
He's been in arrest for seven minutes.
His heart isn't salvageable.
I'm sorry, Mr.
Cray, but if this is what his family wants Please, wait.
We'll continue CPR as long as there's hope for a meaningful recovery, but SAM: You can all come closer if you'd like to be with him.
Call it in five minutes.
Excuse me.
I'll be right back, okay? Hey, we caused this to happen.
No, you caused this to happen.
- So give me a shot at fixing it.
- You're never gonna save him.
The family are not the caretakers.
That man is.
No living will, no durable power.
Go with blood relatives.
We have a chance.
This is a teaching hospital.
- Teach me.
- Oh, you wanna learn.
Okay, well, here you go.
That man's gonna die.
That's what needs to happen right now, so forget about the Digibind.
Lidocaine, one more round of epi, and then you can pronounce him.
Understood? [SIGHS.]
You need a break? Sure.
All right, a hundred of lidocaine.
Get ready for some more epi.
And, uh - Ten vials of Digibind.
- Wait.
I thought the other doctor said Your brother expressed a clear desire for resuscitation earlier.
This is a fixable condition.
We're gonna give it a go.
- Did you discuss this with Pratt? - Yes, we discussed it.
Am I going blind? Oh, bless your heart.
First, check the intraocular pressure with a Tono-Pen.
Um, I'm not sure how to use that.
All right, I'll be right back.
TIMMY: This is interesting.
So how's the new intern doing? She's very, uh, devoted.
Diligent, inquisitive, likes to discover new things.
All attributes I like in a newbie.
Unh.
God, you're disgusting.
- Who left this here? MORRIS & TIMMY: Ray.
Whoa.
If I get a page, I got less than five minutes to get on the roof.
- Where's the Tono-Pen? - Oh, had two stolen, wound up on eBay.
JAY-CO makes us lock everything up now.
Syringes, eye drops, even guaiac developer.
Only Attendings get a key.
I am an Attending.
Make sure you check under the hood.
Ow! Hey, look, is there any rule about desk clerks dating doctors? Shut up, not-Jerry.
I got dibs.
[BEEPING.]
Oh, sweet.
There's a pile-up in Northbrook.
I am so out of here.
[CHUCKLES.]
[MONITOR BEEPING.]
Let's see what we got.
- Sinus tach at 110.
GATES: Got a pulse with that? SAM: Strong carotid.
GATES: Excellent.
Cycle the dynamap.
We got him back for now.
Jimmy.
I'm right here, Jimmy.
SAM: BP's 105/62.
That's good enough for dialysis.
Get the tech back down here.
Mr.
Cray? There are two friends of yours here.
Oh, would you tell them I'll be out in a minute? BENNETT: Uh, they work with us.
Our brother was a lot more screwed up than we realized.
I'm sorry he never told you.
HAROLD: Oh, we knew he was an oddball, antisocial.
We thought he just fell into some sad, Ionely life.
We never realized he was a - Degenerate.
LORRAINE: Harold.
He's not a degenerate.
His life hasn't been a waste.
I know it'd be easier for you to believe that.
He lied to us for years.
Well, he didn't want to.
He didn't see any other way.
You need to go now.
I'm not going anywhere.
You wanna take care of him? Fine.
It doesn't have to be like this.
We need another doc.
This guy is crashing.
All right, call for a vent, 100 percent, AC 14, tidal volume, 600.
Yo, Cue Ball, what's up? [GROANS.]
[HOPE SPEAKING INDISTINCTLY.]
GATES: Oh, that didn't sound good.
- Pressure dropped to 80.
All right, normal saline, wide open, What is she doing? I think it's the 23rd Psalm.
- He doesn't have a line.
GATES: Why? Will you stop that, please? His vitals were stable, crit's 32.
His only complaint was shoulder pain.
- The x-ray was negative GATES: Did you say shoulder pain? - Yeah.
- Type and cross four units.
What happened? Alcoholic with distant trauma history presents shoulder pain and hypotension.
Prep belly for ultrasound.
[BABY COOING.]
NEELA: Hey there.
ABBY: Hey.
I thought you said you were coming alone.
Oh, come on, it's me, Uncle Archie.
Oh, he's so cute.
He looks more like Kovac.
They usually look more like the father in the beginning.
It's nature's way of making sure Daddy doesn't get insecure and club us to death.
Can I hold him? Sure, he wants me to hold him.
[BABY VOMITS.]
Whoop, a little spit-up there.
No problem.
Oh, a little bit more.
I missed this part with my kids.
Oh, I'm so happy to see you.
I was going crazy so I thought I'd take a walk.
I tried paging you.
How's surgery? Oh, I thought it would be nice to get back to work and distract myself from stuff but my new chief is such a rectal tissue.
It's all misery.
Okay, you better take him.
It's starting to get gross.
- Thanks a lot, Morris.
- Here.
Here you go.
So are you loving motherhood? Yeah, uh, it's bizarre.
- Sore nipples? - Shut up.
[BABY CRYING AND ABBY SHUSHING.]
[BEEPING.]
- Oh, I think he's hungry.
- Yeah, maybe.
- Oh, damn it, I've gotta get back.
- Well, thank you for coming.
Well, it's very nice to see you.
Oh.
And nice to see you.
And, uh, call me if you need anything.
- Okay, I'll be back to work next month.
- Bye.
Okay, I think I need to feed him.
Yeah, I'm down with that.
Breast-feeding is a natural thing.
Nothing to be ashamed of.
- You're not sneaking a peek at my tits.
- Okay.
- Come on, Mr.
Rodriguez, wake up.
- Got a 14-gauge in the right wrist.
You got a 14-gauge in? You're gonna have to teach me that one.
This the ruptured spleen? Foley's in.
Who's touching my dick? Not me.
That was only one time, and I was Ionely.
It's a catheter, Mr.
Rodriguez.
Abdomen is flat.
Pressure's up to 100 systolic.
Hey, angel face.
What's going on? Yeah, what is going on? I thought we were going upstairs Dr.
Gates discovered that there was internal bleeding.
- Based on Kerr's sign.
- You caught that? That's my boy.
Everybody knows you be tripping off some phat laced powder Tony's the one you want pushing that Narcan.
High praise indeed.
Check him out now with his fancy M.
D.
Chest sounds clear.
- What are you doing? - Examining him.
It's a little crowded.
Step back, write up the H and P.
- Well, I can't do that un - I will dictate to you.
Chest clear.
Cardiac S1, S2 without murmur, rub or gallop.
Am I going too fast for you? Hey, I heard Faith's guy was crashing.
Her name is Hope.
I think it's okay.
Good, well, we're done in there.
You guys called it? Uh, no, actually, the Digibind worked.
- Neela, check a quick rectal.
- I have to do the rectal exam? Gates, what part of " no Digibind" did you not get? - It worked.
PRATT: So what? You got his heart back, but his brain is shot.
Now he'll be comatose for three weeks until his organs fail.
- You don't know that for sure.
- What did you just say to me? I'm an intern, not an idiot.
Been patching up Then maybe next time, you'll know the difference between Diovan and didge.
- If what I'm told doesn't make sense to me, you got that? I've been in this ER for five years working my way up as an Attending so if you think that you're gonna spout some crap like that to me then we got a lot more to talk about.
Now get the hell out.
Okay, I was out of line.
Can I check the rapid infuser? - Get out of here.
- I'm working.
Not anymore.
- Shift's over.
- Oh, yeah? WEAVER: Pressure's stable.
- O.
R.
Is ready.
MARQUEZ: Sats 92 on 4 liters.
- Stool is brown, guaiac negative.
CRENSHAW: Good.
Let's squeeze in two units, portable monitor, let's move him up.
Thank you, Jesus.
I thought you were gone.
Working on my charts.
Listen, I know I made a mistake, but that guy would have needed calcium anyway.
If I had known about the didge, I'd have used a lower dose.
- Pushed it very slowly.
- I said I was wrong.
What do you want from me? How about, " I won't ever again flat-out disregard something you tell me to do or not do"? He would have wanted the Digibind.
- So what? - So what? That's gotta matter.
It was a judgment call that wasn't yours to make.
If you can't give weight to my judgment on a patient that I've been treating [EXHALES SHARPLY.]
- What? - No.
No, no, no, go ahead.
Finish the sentence.
Nope.
Yeah.
From now on, you chart as you go.
No more of this saving the paperwork for the end of the day.
And next time you don't do what I tell you to do or any other Attending tells you you're gonna find yourself getting bum rushed right out of this program.
- I was wrong from your point of view - From my point of view? Because of the Digibind, that guy has a chance.
You really think that you saved him? Is that what you think? Oh, then he's gotta have a corneal reflex.
- No.
- Cold calorics? Absent.
And negative doll's eyes, right? That means no sign of brain activity.
No chance for recovery.
So as your, uh, favorite new mentor, let me just say, great save, Dr.
Gates.
[DOOR OPENS AND CLOSES.]
Hey.
How's your first day going? Guy comes in with a few scrapes, ends up with a splenectomy.
Well, sounds like a good case.
Yeah, it does sound like one.
I wouldn't know, because Dr.
Crenshaw won't let me scrub in.
Sent me to do dressing changes.
Yeah, he's a stern taskmaster, that Dusty.
I'm an intern, Lucien.
Nurses do wound changes.
You know what? That's his call.
You assured me this would be a step up.
Two months ago, I was harvesting saphenous veins for a CABG procedure.
- Now I can't hold a retractor? - It's only the first day.
Why recruit me if you won't allow me to do anything? He's tough, I know that, but his methods work.
He needs to break you down to un-learn you of your bad habits.
What am I, a pony? I don't need to be broken.
I'm not gonna learn or un-learn anything by standing out in the hall.
Neela, you're in a different culture now.
This is how we shake the ER out of you and build you up again as a surgeon.
Well, does it have to be so humiliating? No, it's just much more effective that way.
[CHATTERING.]
Oh.
- I was wondering where you went.
- Yeah, I was taken off the case.
Yes, I thought I detected some tension.
- Where are the Andersons? - Oh, they won't stay as long as I'm here.
Even Brian.
Well, it's nice your friends came.
They want me to go to the club.
Do the show.
Well, they're gonna move him to ICU.
We won't know anything for 24 hours.
Maybe you should go.
He's not coming back from this, is he? - There's something I should tell you - No.
You made a mistake, got something wrong about the didge.
It contributed to his heart problems.
I've been around hospitals long enough to get that much.
- I'm so sorry.
- No.
You treated him well.
Both of us.
We appreciate it.
Maybe they were right.
Maybe he was ready.
This has been coming for a long time.
[SIGHS.]
But here's the thing.
As bad as it all may sound, I belong to a rare tribe constitutionally incapable of giving up on fantasy.
If I can get up like a lady and sell a torch song to a crowd then I sure as hell can hold onto the hope that maybe, somehow Jimmy's gonna be okay.
You make me wish I were a drag queen.
[BENNETT LAUGHING.]
No.
We are all liars, just like they said.
The makeup, the wig, the padded dress.
All a beautiful lie we tell ourselves.
But it makes us feel better.
Nothing wrong with that.
No, nothing at all.
Thank you, doctor.
Hope, impacted cerumen needs a washout in 1 and migraine lady needs an H and P The abridged version, please.
- In Curtain 4.
Oh, and hey, uh, you know, once we're done here maybe we could go over some procedures and stuff.
Help orient you.
Maybe over dinner? You're asking me out? No, no, I mean, not exactly.
I mean, you know, yeah.
Have you accepted Jesus in your life? Jesus in Accounting or? Oh, yeah, well, sure, yeah.
I mean, I've thought about it.
- You haven't, have you? - Yes, yes, I have.
Jesus is totally cool.
I mean, to me, anyway.
You should come to my Bible group sometime.
I think you'd really like it.
Bible group? - Okay.
- Great.
The next one's Wednesday night.
Bible group.
That's hot, right? Trust me, carrot boy, you ain't anywhere near tapping that.
You know, if there's anything you need I mean, if I can help make your adjustment smoother.
- In any way.
- I'll let you know.
Um, things are a bit complicated right now.
Yeah, for me too.
- But maybe we can get some? - Coffee? - Coffee or something? - Yeah.
- Sometime? - Coffee would be good.
[ELECTRICITY SURGES.]
[CHATTERING.]
Okay, then.
- Well - Good night.
[KNOCKING ON DOOR.]
- Hey, kiddo.
- Hey, Mom.
I, uh, talked to Dr.
Alice today.
She said you were quiet.
Do you not like her? [SIGHS.]
Scoot.
[ALEX SIGHS.]
Now, you've been through a lot, you know.
We both have.
I just wanted you to have her to talk to.
- I can't.
- Yeah, you can.
- That's what she's there for.
- No, Mom, I can't.
[SIGHS.]
I saw.
You know, Dad on the ground, just sleeping.
I saw what you did.
[KEYS JINGLING.]
Did you remember the wine? I knew there was a reason I let you live here.
So were you the best one there? How many people did you save? Did you rock? [JAZZ MUSIC PLAYING ON PIANO.]
[SIGHS.]
[SINGING " YOU'RE NOBOD Y TILL SOMEBOD Y LOVES YOU".]
Practice questions and instructions are in the packet.
Shouldn't we learn something before you start testing us? It's to get a baseline.
We'll re-test you at the end of the year.
Um, is there a makeup date? Friday's my day off.
I volunteer at Big Sister/Little Sister.
Yeah, well, I'm post-call, which means I volunteer to sleep all day.
Well, too bad.
Conference room, 8 a.
m.
KOVAC: Come on, guys.
PRATT: Who else is on? Weaver is on at 12.
Until then, you're in charge.
- What about Morris? - He just called.
He's running late, he said start without him.
For his first shift as an Attending? Did he say why? I couldn't understand him.
It was windy and the music was loud.
MARQUEZ: Ma'am.
- Windy? [JOEY SCARBURY'S "BELIEVE IT OR NOT" PLAYS ON RADIO.]
[SINGS " BELIEVE IT OR NOT".]
Rat-bite kid is in Bed C.
Waiting on a shot of penicillin and a piece of pizza.
- Oh, the surgeon is in.
- I think I left my badge here.
- Are you nervous? - No, I'm okay.
- Happy rounding.
- First day, don't let them haze you.
WOMAN: The sidewalk was crooked.
I wanna talk to Johnnie.
You're gonna have to call them back later.
Look, J.
Lo, I got 10 minutes left on my card and I ain't signing until I talk to my attorney.
Don't tell me Johnnie Cochran's dead.
MARQUEZ: Give me a break.
- Let me help.
- It's not heavy.
- They found some bad wiring.
The whole place is like a tinderbox.
Really? Got a light? James Anderson, shortness of breath, history of heart failure.
Gave nitro spray and 40 of Lasix.
The guy's a chronic CHF'er.
Forty won't do the trick, he needs 80.
Protocol says 40.
Not that I'd expect you to know or give a damn.
Picked him up in the hall of his apartment.
Place had some wild stuff.
- Feather boas, stiletto heels.
- One, two, three.
GATES: Sounds like your locker.
What meds is he on? It's on the paramedic sheet, which is also part of Protocol, right.
I smell a theme.
SAM: Eighty of Lasix.
- Unh.
- Sats suck.
GATES: Must have a bad lead.
He does.
Look at this, it's on his chest hair.
Is that part of the? What do you call it, protocol? Isordil, Bumex, glyburide.
- Benzoin for the chest lead.
NURSE: Here you go.
GATES: All right.
Protonix, Diovan and carvedilol.
Let me help you.
- All right, sats are up.
- Lasix in.
Hey, can you look at me? - It's good.
- Saved your ass again, Zades.
Hey, where's that famous sense of humor of yours? You know, it was bad enough before.
Now I gotta roll in, have you play me because somebody gave you a white coat? - What are you so pissed off about? - I'm on probation for a month.
Limited shifts, no extra runs, and one wrong move, I'm finished.
What? Those two drunk guys outside of Ike's press charges? No, the bar manager filed a complaint, so chief's gotta make sure I feel it.
- I didn't hear anything about it.
- Well, of course not, you're Mr.
Teflon.
- Only now it's Dr.
Teflon.
- It's no big deal.
- What's probation, a month? - It's my job, man.
My job.
You know, the one good thing about you working here: You may just have to listen to somebody besides yourself once in a while.
And I can't wait to see those sparks fly.
I'll catch you later, killer.
[BUZZES.]
Well, he didn't mean " killer" killer.
He meant You know All right, back to work, everyone.
Barack.
Barack Obama.
Don't waste my time, put him on.
[CRASHING.]
[CLASSICAL MUSIC PLAYING ON PIANO.]
[CHATTERING.]
[KNOCKS ON DOOR.]
MAN: Benny, your neighbor's on the phone.
Something about Jim.
[CHATTERING.]
Excuse me.
Triage desk.
Uh, no, I'm here for someone, James Anderson.
They brought him in an hour ago, I think.
Triage desk.
Thank you.
[SIREN WAILS.]
- Hello, l - Fill out this form, sir.
I'm here to see a patient.
Oh, okay.
Then try this one.
[BABY CRIES.]
[LIGHT SPARKS.]
Easy, now.
We got enough patients already.
Charity, I got one for you.
I'm Hope, my name is Hope.
Right, 8-year-old girl fell off her bike.
Oh, poor little angel.
PRATT: Hey, think fast.
- Whoa.
What's this? - It's your lucky day.
Residents get to wear the new transport beeper.
If this thing goes off, I can sign out my patients and go, right? Well, if your Attending, i.
e.
Me, agrees that the patient is critical and needs a physician transport, then, yes, Ray, you may go.
Sweet, I'm gonna go check the transpo locker.
- Is Dr.
Kovac around? - Hey, how you doing? I think Dr.
K ran upstairs but I'm pretty sure I can help you with anything you need.
You represent this hospital and that's how you approach people asking for help? KOVAC: Angela? I was waiting for you upstairs.
I'm sorry, my train was late.
But I had the lovely opportunity to meet " Dr.
Pratt.
" Impressive.
- Got a minute? - Yeah, sure.
[MOUTHING.]
What? Haleh, what the hell just happened? I think you got served.
- Greg Pratt, Timmy Rawlins.
- Hey.
- He's gonna be filling in for Jerry.
PRATT: Really? In fact, he was Jerry before Jerry was Jerry.
PRATT: Wow.
Yeah, back in the mid-'90s.
Got stuck in a rut.
I had to get out.
- Out of the hospital? - No, out of Chicago.
I lived in the Kalahari for a while, selling biltong outside of Kakamas.
Then I spent a couple years mining uranium in the Siberian tundra.
Ran into a misunderstanding in Thailand, that landed me in the Bangkwang prison.
- But most of the '90s is still a blur.
PRATT: Wow, sounds rugged.
Hell, I'd take Bangkwang over ER this time of year.
As you know, them new interns will mess you up worse than Chinese hash.
Ain't that the truth? [MACHINE TOOLS BUZZING.]
It's about the Curtis Ames case.
Risk Management wants to meet tomorrow at 9 a.
m.
Curtis Ames? Left-sided paralysis following an embolic stroke.
You placed a central line for pneumonia and he boarded down here for three days.
February of '04? Oh, oh, oh.
But I thought the case had no merit.
Ha.
Guy wants his day in court.
But the lawyer said - It's been a year since my deposition.
TIMMY: Excuse me.
- Angela from Staff Affairs? - Ms.
Gilliam.
Ms.
Gilliam, Dr.
Tremons on the phone, he says his privileges have been Tell him the Anesthesia chair has to keep his ACLS current just like every other physician in this hospital.
Okay.
I got you, baby.
Look, malpractice suits are a waste of time and resources but it happens to almost every doctor at some point.
It doesn't reflect on your abilities as a physician.
See you tomorrow.
Ultrasound confirmed cholecystitis.
Hang a bag of ertapenem, send her to surgery.
I'll give the nursing report.
Scaphoid fracture, thumb spica in Bed A.
- Discharge with clinic referral.
- No problem.
This one over here? Curling iron, upper inner thigh.
Dressing and tetanus, and, uh, send her on her way.
- How do you even know that? - Don't ask, don't tell.
Pratt, sign Gates up for some more.
- The man knows how to clear a bed.
- Really? Why do I have patients with blank charts and I haven't heard about your CHF guy? - He's stable.
We're waiting on labs.
- His sats are 91.
He's hypoxic.
- That was before oxygen and Lasix.
- What's the EKG show? Nothing to worry about.
This gentleman's here for James Anderson.
- You family? - We're business partners.
My name's Cray.
Bennett Cray.
All right.
Dr.
Gates can take you in.
- But keep me apprised.
- All right.
We're waiting on some test results but, uh, we could use information on his medical status.
Yes, I can help with that.
I brought in his meds.
Your, uh, mascara's running.
Oh.
It was a long night.
You round twice a day, In between, you'll cover floor patients and consults.
And hopefully scrub in on a few cases? Sure.
Neela, this is Jill Connelly and Ken Maser, your fellow interns.
And this is Dr.
Crenshaw.
CRENSHAW: Sweet urine of a hairless eunuch.
DUBENKO: Dustin? CRENSHAW: No, I don't think so.
What I asked for was a freaking ginger ale.
DUBENKO: Dustin? Dustin? Dr.
Crenshaw is our new Chief Resident.
Neela Rasgotra.
Put in two years in the ER, then defected to become a real doctor.
Wow, it took you that long to figure out you were wasting your time? - Oh, I don't think of it that way.
- Really? And why is that? I developed clinical and procedural skills.
[YAWNS.]
I became proficient at ultrasounds, central lines, chest tubes, cutdowns.
Wow, you know what worries me? Maybe all of this is gonna seem too easy.
You think? Think there's a chance you might be Oh, I don't know.
What's the word, um bored by what we do up here? - I don't think so.
- Good.
Good.
Then I think I'll leave you all to it.
Bye.
CRENSHAW: Someone want to explain to our international prodigy here how we do wound rounds? [MONITOR BEEPING.]
Mr.
Cray.
BENNETT: Doctor.
His oxygen level is up.
He should be waking soon.
Is there any family he'd like here? Uh, just me.
That's all.
Just the two of us.
We each come from a long line of homophobes and bigots.
The closet reflex dies hard.
- How long have you two been together? - It's been over 15 years now.
We found each other late.
He thought no one'd ever love him, and I'd already resigned myself to being a Ionely old drag queen.
In the right light, he looks like Barbara Stanwyck in The Lady Eve.
Ha.
To you, maybe.
Now I look more like Mrs.
Doubtfire.
I'll let you two talk, and, uh, I'll be back as soon as I know anything, okay? Hey, Luka, can you sign a wrist x-ray order for the Obama lady? Sure.
I hear the baby's doing well.
- He's starting to hold his head up.
- Oh, that's great.
We never got to talk about everything that happened.
It's not your fault, Sam.
If it wasn't for me If it wasn't for you, I'd be dead.
How is everything? It's good.
You know, pretty good.
I, uh Alex is seeing this shrink lady, but he's not really into it.
- He likes to keep everything bottled up.
- I meant with you.
I'm fine.
Really.
[SIREN BLARING.]
You want me to try talking to Alex? No, you've got enough on your plate, uh but thank you.
- Sam, hey.
Just don't beat yourself up.
You did what you had to do.
It was self-defense.
HOPE: Born in a poor village in central Guatemala Soledad Guttierrez is an immigrant who works cleaning houses.
She's had a hard time adjusting to life in the U.
S.
Wow, you really bonded with her.
Felicity, hurry up and get to the point, will you? Soledad is worried every day and prays all the time for her husband and 4-year-old son back in their hometown of " Chichicastenango.
" Oh, sure, I got down to Chichi for el DÃa de los Muertos back in '96.
She's thorough, there's no denying that.
- But she's getting older and might not PRATT: Look, look, look.
I don't need her whole life story.
Why is she in the ER today? Well, she had a great uncle who died of a heart attack.
His wife and children were left without anyone so they had to move in with her parents All right, stop, stop, stop.
What brought her to the ER? Her heart.
It's her heart.
Good, so do you think it's an MI? Pericarditis? Dysrhythmia? Well, she's been unable to find a suitable church so I believe that she feels so alone in this world that her heart is aching for her family and her homeland.
Okay, okay, well, diagnostically, what you just said is nothing.
SAM: Need a hand here.
- Group home resident, 22 years old.
MAN: Release me, you merchants of destruction! - You need to stay in bed.
- Morris.
Good to see you.
Glad you could make it.
Oh, the pleasure's all mine.
The home thinks he might have ingested something.
All right, 10 of Haldol, 2 of Ativan I.
M.
Oh, this is Rodney King all over again.
- Hey, no pictures in here.
- You ain't fooling nobody.
- Harriet, get back to your bed.
- Obama gonna see this.
[LAUGHING.]
How you feeling, Mr.
Anderson? Oh, better.
Tell him he can go.
He's got a show tonight.
We're having a fundraiser for the Chicago HIV/ AIDS Coalition.
And I don't want you missing it on account of me.
He never misses a show.
Fine.
Listen, we have some test results.
Good news is you did not have a heart attack.
- Oh, thank God.
- But you're not making urine which means your kidneys aren't working, so you'll have to go on dialysis.
- I don't think so.
- Jim.
- It's pretty urgent.
- I've been to enough doctors already.
Had enough tubes and machines and treatments.
- No, I'm not gonna do it, don't ask me.
BENNETT: It's okay, Jim.
It's okay.
So, what else can we try? What are his other options? His options? Well, dying.
Very soon.
[MONITOR BEEPING.]
No, it's enough already.
Jim, there's no choice.
Dialysis can substantially prolong your life.
I already got the bad heart.
I'm sick of being sick.
I'm not gonna be some broken-down cripple.
You're tired, I know that.
- But remember what we always said? - It's enough.
- Choose more life.
- Whatever's gonna happen.
- No matter what, remember? More life.
- I don't wanna do this to you.
You promised.
Okay.
Okay.
But you gotta do something for me.
Call Lorraine and tell her what's going on.
- Jim.
- Call her.
Just tell her to bring the boy.
I wanna see him.
It's not a good idea.
Don't get into it all.
Don't try to explain it.
Just tell her I wanna see them.
It's been too long.
Please, Benny.
You got to do it.
All right.
His sister and her son.
I've never met them.
So dialysis? Yeah, let's get him up as soon as we can.
I'll make the call.
Hmm.
He was already 50 by the time he figured it out.
He wanted to tell his family, but they shut him down.
So he just left.
Disappeared one day.
Found me.
No openings now, but I told them we could start him down here.
His serum K level is still high.
All right, amp of bicarb, 25 grams of D50, 10 units of regular insulin.
- May I use that phone? - Sure.
There's one down the hall if you want privacy.
Thank you.
Oh, excuse me.
Gates, Rheumatology came down on the polymyositis patient.
- No H and P on the chart.
- Didn't get to it yet.
No, that's not good enough.
Sam, you got this? - You come with me.
GATES: All right.
Give me an ETA on the dialysis.
I got enough problems without you pissing off other departments by not keeping current on your charts.
- Trying to use my time well.
- Not enough.
Get that up-to-date.
- Thank God, someone who understands.
- Rough morning, Greg? I'm glad to have you.
Will you come check my vertical mattress? I think I everted the edges too much.
- Not until he listens to my bronchiolytic.
- Did you try a neb? Don't worry, I'll show you.
I'm with Dr.
Pratt today.
Okay.
I need to present my barbell-on-the-toe guy.
I can help you with that.
Hey, guys, this is the esteemed Dr.
Weaver in the house, okay? So take advantage.
Present to her.
Soak up all her decades of experience.
Decades? What am I, a fossil? All right, go run and hide.
We'll be there in a minute.
You know what? I'm fine.
I'll push charts, help clear some beds.
- I hope this isn't awkward.
- What? - That you and I are equals now? - I guess.
Hector Rodriguez, 38.
Found on the sidewalk.
Hey, there's Tony.
Tony, man.
- Cue Ball, what are you doing here? - Some misunderstanding.
- History of ETOH.
- We know.
- Did you vomit any blood? - Not this time.
I was just sleeping and some skank called 911.
Where do you want him? - Did you fall? - Oh, no, no.
That's old.
- A junkie rolled me weeks ago.
- Yeah, occupational hazard.
Hope, get this dude to Exam 3.
- I got him.
I know him.
- Look for signs of occult trauma.
- Yes, sir, Dr.
Pratt.
- I can get him.
You finish that.
Is that the bleeding heart of Jesus? Sure is.
Isn't God great? You ain't so bad yourself, honey.
There were no open spots upstairs, so we're starting him on dialysis here.
Is that Uncle Jimmy in there? Hello, uh, Lorraine? You're the man I talked to on the phone? Bennett Cray.
My brother, Harold, and my son, Brian.
James asked you to call us? He wanted to see his family.
Now? Like this? It's par for the course, I guess.
TECHNICIAN: He's having ectopy.
Runs of six.
Damn it.
Get Gates and Pratt in here.
His K's going up again.
Ejection fraction is 10 percent.
What does that mean? It means his heart's not pumping well enough.
SAM: He have an advanced directive? - You mean like a DNR? No, I talked to the other doctor about this.
Well, why are you asking about a DNR? We need to know how far he'd want us to go.
- Whatever you can.
- We knew he was sick I talked to him, he said he was having problems with his diabetes and some trouble with his congestive something.
He called you? Yeah, in June, when I graduated.
What are his chances? Well, it's possible if we put him on dialysis, avert a cardiac incident Can he take all that? He's very resilient.
- He's been through a lot.
HAROLD: He's been sick for years.
He's not the type to wanna be kept alive on machines.
Well, your brother and I have discussed these matters.
We need a few minutes to figure this out.
- Sure.
- Maybe I can be of some help.
Jim and I are good friends.
We've been together for quite a while now.
Thank you, this is a family matter.
We appreciate all you've done.
We'd like some privacy now.
Oh, yes, all right, I'll just step outside.
SAM: QRS complex is widening.
TECHNICIAN: Ready to start the run.
PRATT: Wait a minute.
Hold on.
Sam? Where's Gates, and why is this chart blank? He goes fast.
He probably fills out the paperwork later.
- You got this guy's meds in your notes? - Yeah.
[SIGHS.]
Okay.
Amp of calcium chloride.
TECHNICIAN: We doing this? - Yeah, in a minute.
Let me give him calcium to stabilize his heart.
Once we do, we'll figure out what's next.
Okay.
WEAVER: Hey, Haleh? Pass me a head sheet and Vicodin? Get him started on something for the pain.
Sorry, we got rid of head sheets about a year ago and we're not allowed to dispense meds from the ER anymore.
What's a patient supposed to do if they can't get to a pharmacy? You are preaching to the choir, sister.
I liked it better when you ran the joint.
PRATT: Charged.
Clear.
Still V-fib.
Resuming compressions.
- What happened? PRATT: Amp of epi.
Why isn't he dialyzed? QRS widened.
Gave him calcium, and now he's crashing.
Is my uncle dying? [WATCH BEEPING.]
What's that alarm? It's his meds.
He gets afternoon doses of glyburide, Lasix and didge.
What? - Did you say didge? - Digoxin, 0.
25 milligrams.
It's right here.
Can everybody step back for a minute while we work on him, please? Charge to 360 again.
LORRAINE: You help my brother with his medication? BENNETT: Sometimes, yes.
No one said didge.
You showed me Diovan.
- That's what I was told.
- By who, the paramedic? What does Zadro's sheet say? Digoxin.
- You didn't look at his med bottles? - We didn't have them yet.
He has high levels of intracellular calcium from the didge and I pushed more, enough to stop his heart.
Why? Because you couldn't slow down enough to read the med sheet right.
BENNETT: Can you tell me what's going on? [SIGHS.]
The drugs we gave him to treat his QRS has irritated his heart.
[PADDLES CHARGING.]
Clear.
Clear.
No change.
Uh, so, what now? What else can we do? Hey, what about Digibind? Depends on his DNR status.
Have you all come to a decision? We've decided it's enough now.
It's time to let him go.
- What? No.
- Our brother's an old man.
- He's been sick for a long time.
- No.
- He wants to fight.
- He's got no one.
He has friends.
A support system.
And who's gonna take care of him? - You? - I always have.
We're his blood.
We don't think he'd wanna suffer through all this.
You don't know that.
You don't know him.
- But I do.
- And that was his choice, not ours.
I love him.
I love him.
I asked you once politely to go.
You have no part in this.
We can treat your brother with Digibind.
It'll give him a fighting chance.
He's been in arrest for seven minutes.
His heart isn't salvageable.
I'm sorry, Mr.
Cray, but if this is what his family wants Please, wait.
We'll continue CPR as long as there's hope for a meaningful recovery, but SAM: You can all come closer if you'd like to be with him.
Call it in five minutes.
Excuse me.
I'll be right back, okay? Hey, we caused this to happen.
No, you caused this to happen.
- So give me a shot at fixing it.
- You're never gonna save him.
The family are not the caretakers.
That man is.
No living will, no durable power.
Go with blood relatives.
We have a chance.
This is a teaching hospital.
- Teach me.
- Oh, you wanna learn.
Okay, well, here you go.
That man's gonna die.
That's what needs to happen right now, so forget about the Digibind.
Lidocaine, one more round of epi, and then you can pronounce him.
Understood? [SIGHS.]
You need a break? Sure.
All right, a hundred of lidocaine.
Get ready for some more epi.
And, uh - Ten vials of Digibind.
- Wait.
I thought the other doctor said Your brother expressed a clear desire for resuscitation earlier.
This is a fixable condition.
We're gonna give it a go.
- Did you discuss this with Pratt? - Yes, we discussed it.
Am I going blind? Oh, bless your heart.
First, check the intraocular pressure with a Tono-Pen.
Um, I'm not sure how to use that.
All right, I'll be right back.
TIMMY: This is interesting.
So how's the new intern doing? She's very, uh, devoted.
Diligent, inquisitive, likes to discover new things.
All attributes I like in a newbie.
Unh.
God, you're disgusting.
- Who left this here? MORRIS & TIMMY: Ray.
Whoa.
If I get a page, I got less than five minutes to get on the roof.
- Where's the Tono-Pen? - Oh, had two stolen, wound up on eBay.
JAY-CO makes us lock everything up now.
Syringes, eye drops, even guaiac developer.
Only Attendings get a key.
I am an Attending.
Make sure you check under the hood.
Ow! Hey, look, is there any rule about desk clerks dating doctors? Shut up, not-Jerry.
I got dibs.
[BEEPING.]
Oh, sweet.
There's a pile-up in Northbrook.
I am so out of here.
[CHUCKLES.]
[MONITOR BEEPING.]
Let's see what we got.
- Sinus tach at 110.
GATES: Got a pulse with that? SAM: Strong carotid.
GATES: Excellent.
Cycle the dynamap.
We got him back for now.
Jimmy.
I'm right here, Jimmy.
SAM: BP's 105/62.
That's good enough for dialysis.
Get the tech back down here.
Mr.
Cray? There are two friends of yours here.
Oh, would you tell them I'll be out in a minute? BENNETT: Uh, they work with us.
Our brother was a lot more screwed up than we realized.
I'm sorry he never told you.
HAROLD: Oh, we knew he was an oddball, antisocial.
We thought he just fell into some sad, Ionely life.
We never realized he was a - Degenerate.
LORRAINE: Harold.
He's not a degenerate.
His life hasn't been a waste.
I know it'd be easier for you to believe that.
He lied to us for years.
Well, he didn't want to.
He didn't see any other way.
You need to go now.
I'm not going anywhere.
You wanna take care of him? Fine.
It doesn't have to be like this.
We need another doc.
This guy is crashing.
All right, call for a vent, 100 percent, AC 14, tidal volume, 600.
Yo, Cue Ball, what's up? [GROANS.]
[HOPE SPEAKING INDISTINCTLY.]
GATES: Oh, that didn't sound good.
- Pressure dropped to 80.
All right, normal saline, wide open, What is she doing? I think it's the 23rd Psalm.
- He doesn't have a line.
GATES: Why? Will you stop that, please? His vitals were stable, crit's 32.
His only complaint was shoulder pain.
- The x-ray was negative GATES: Did you say shoulder pain? - Yeah.
- Type and cross four units.
What happened? Alcoholic with distant trauma history presents shoulder pain and hypotension.
Prep belly for ultrasound.
[BABY COOING.]
NEELA: Hey there.
ABBY: Hey.
I thought you said you were coming alone.
Oh, come on, it's me, Uncle Archie.
Oh, he's so cute.
He looks more like Kovac.
They usually look more like the father in the beginning.
It's nature's way of making sure Daddy doesn't get insecure and club us to death.
Can I hold him? Sure, he wants me to hold him.
[BABY VOMITS.]
Whoop, a little spit-up there.
No problem.
Oh, a little bit more.
I missed this part with my kids.
Oh, I'm so happy to see you.
I was going crazy so I thought I'd take a walk.
I tried paging you.
How's surgery? Oh, I thought it would be nice to get back to work and distract myself from stuff but my new chief is such a rectal tissue.
It's all misery.
Okay, you better take him.
It's starting to get gross.
- Thanks a lot, Morris.
- Here.
Here you go.
So are you loving motherhood? Yeah, uh, it's bizarre.
- Sore nipples? - Shut up.
[BABY CRYING AND ABBY SHUSHING.]
[BEEPING.]
- Oh, I think he's hungry.
- Yeah, maybe.
- Oh, damn it, I've gotta get back.
- Well, thank you for coming.
Well, it's very nice to see you.
Oh.
And nice to see you.
And, uh, call me if you need anything.
- Okay, I'll be back to work next month.
- Bye.
Okay, I think I need to feed him.
Yeah, I'm down with that.
Breast-feeding is a natural thing.
Nothing to be ashamed of.
- You're not sneaking a peek at my tits.
- Okay.
- Come on, Mr.
Rodriguez, wake up.
- Got a 14-gauge in the right wrist.
You got a 14-gauge in? You're gonna have to teach me that one.
This the ruptured spleen? Foley's in.
Who's touching my dick? Not me.
That was only one time, and I was Ionely.
It's a catheter, Mr.
Rodriguez.
Abdomen is flat.
Pressure's up to 100 systolic.
Hey, angel face.
What's going on? Yeah, what is going on? I thought we were going upstairs Dr.
Gates discovered that there was internal bleeding.
- Based on Kerr's sign.
- You caught that? That's my boy.
Everybody knows you be tripping off some phat laced powder Tony's the one you want pushing that Narcan.
High praise indeed.
Check him out now with his fancy M.
D.
Chest sounds clear.
- What are you doing? - Examining him.
It's a little crowded.
Step back, write up the H and P.
- Well, I can't do that un - I will dictate to you.
Chest clear.
Cardiac S1, S2 without murmur, rub or gallop.
Am I going too fast for you? Hey, I heard Faith's guy was crashing.
Her name is Hope.
I think it's okay.
Good, well, we're done in there.
You guys called it? Uh, no, actually, the Digibind worked.
- Neela, check a quick rectal.
- I have to do the rectal exam? Gates, what part of " no Digibind" did you not get? - It worked.
PRATT: So what? You got his heart back, but his brain is shot.
Now he'll be comatose for three weeks until his organs fail.
- You don't know that for sure.
- What did you just say to me? I'm an intern, not an idiot.
Been patching up Then maybe next time, you'll know the difference between Diovan and didge.
- If what I'm told doesn't make sense to me, you got that? I've been in this ER for five years working my way up as an Attending so if you think that you're gonna spout some crap like that to me then we got a lot more to talk about.
Now get the hell out.
Okay, I was out of line.
Can I check the rapid infuser? - Get out of here.
- I'm working.
Not anymore.
- Shift's over.
- Oh, yeah? WEAVER: Pressure's stable.
- O.
R.
Is ready.
MARQUEZ: Sats 92 on 4 liters.
- Stool is brown, guaiac negative.
CRENSHAW: Good.
Let's squeeze in two units, portable monitor, let's move him up.
Thank you, Jesus.
I thought you were gone.
Working on my charts.
Listen, I know I made a mistake, but that guy would have needed calcium anyway.
If I had known about the didge, I'd have used a lower dose.
- Pushed it very slowly.
- I said I was wrong.
What do you want from me? How about, " I won't ever again flat-out disregard something you tell me to do or not do"? He would have wanted the Digibind.
- So what? - So what? That's gotta matter.
It was a judgment call that wasn't yours to make.
If you can't give weight to my judgment on a patient that I've been treating [EXHALES SHARPLY.]
- What? - No.
No, no, no, go ahead.
Finish the sentence.
Nope.
Yeah.
From now on, you chart as you go.
No more of this saving the paperwork for the end of the day.
And next time you don't do what I tell you to do or any other Attending tells you you're gonna find yourself getting bum rushed right out of this program.
- I was wrong from your point of view - From my point of view? Because of the Digibind, that guy has a chance.
You really think that you saved him? Is that what you think? Oh, then he's gotta have a corneal reflex.
- No.
- Cold calorics? Absent.
And negative doll's eyes, right? That means no sign of brain activity.
No chance for recovery.
So as your, uh, favorite new mentor, let me just say, great save, Dr.
Gates.
[DOOR OPENS AND CLOSES.]
Hey.
How's your first day going? Guy comes in with a few scrapes, ends up with a splenectomy.
Well, sounds like a good case.
Yeah, it does sound like one.
I wouldn't know, because Dr.
Crenshaw won't let me scrub in.
Sent me to do dressing changes.
Yeah, he's a stern taskmaster, that Dusty.
I'm an intern, Lucien.
Nurses do wound changes.
You know what? That's his call.
You assured me this would be a step up.
Two months ago, I was harvesting saphenous veins for a CABG procedure.
- Now I can't hold a retractor? - It's only the first day.
Why recruit me if you won't allow me to do anything? He's tough, I know that, but his methods work.
He needs to break you down to un-learn you of your bad habits.
What am I, a pony? I don't need to be broken.
I'm not gonna learn or un-learn anything by standing out in the hall.
Neela, you're in a different culture now.
This is how we shake the ER out of you and build you up again as a surgeon.
Well, does it have to be so humiliating? No, it's just much more effective that way.
[CHATTERING.]
Oh.
- I was wondering where you went.
- Yeah, I was taken off the case.
Yes, I thought I detected some tension.
- Where are the Andersons? - Oh, they won't stay as long as I'm here.
Even Brian.
Well, it's nice your friends came.
They want me to go to the club.
Do the show.
Well, they're gonna move him to ICU.
We won't know anything for 24 hours.
Maybe you should go.
He's not coming back from this, is he? - There's something I should tell you - No.
You made a mistake, got something wrong about the didge.
It contributed to his heart problems.
I've been around hospitals long enough to get that much.
- I'm so sorry.
- No.
You treated him well.
Both of us.
We appreciate it.
Maybe they were right.
Maybe he was ready.
This has been coming for a long time.
[SIGHS.]
But here's the thing.
As bad as it all may sound, I belong to a rare tribe constitutionally incapable of giving up on fantasy.
If I can get up like a lady and sell a torch song to a crowd then I sure as hell can hold onto the hope that maybe, somehow Jimmy's gonna be okay.
You make me wish I were a drag queen.
[BENNETT LAUGHING.]
No.
We are all liars, just like they said.
The makeup, the wig, the padded dress.
All a beautiful lie we tell ourselves.
But it makes us feel better.
Nothing wrong with that.
No, nothing at all.
Thank you, doctor.
Hope, impacted cerumen needs a washout in 1 and migraine lady needs an H and P The abridged version, please.
- In Curtain 4.
Oh, and hey, uh, you know, once we're done here maybe we could go over some procedures and stuff.
Help orient you.
Maybe over dinner? You're asking me out? No, no, I mean, not exactly.
I mean, you know, yeah.
Have you accepted Jesus in your life? Jesus in Accounting or? Oh, yeah, well, sure, yeah.
I mean, I've thought about it.
- You haven't, have you? - Yes, yes, I have.
Jesus is totally cool.
I mean, to me, anyway.
You should come to my Bible group sometime.
I think you'd really like it.
Bible group? - Okay.
- Great.
The next one's Wednesday night.
Bible group.
That's hot, right? Trust me, carrot boy, you ain't anywhere near tapping that.
You know, if there's anything you need I mean, if I can help make your adjustment smoother.
- In any way.
- I'll let you know.
Um, things are a bit complicated right now.
Yeah, for me too.
- But maybe we can get some? - Coffee? - Coffee or something? - Yeah.
- Sometime? - Coffee would be good.
[ELECTRICITY SURGES.]
[CHATTERING.]
Okay, then.
- Well - Good night.
[KNOCKING ON DOOR.]
- Hey, kiddo.
- Hey, Mom.
I, uh, talked to Dr.
Alice today.
She said you were quiet.
Do you not like her? [SIGHS.]
Scoot.
[ALEX SIGHS.]
Now, you've been through a lot, you know.
We both have.
I just wanted you to have her to talk to.
- I can't.
- Yeah, you can.
- That's what she's there for.
- No, Mom, I can't.
[SIGHS.]
I saw.
You know, Dad on the ground, just sleeping.
I saw what you did.
[KEYS JINGLING.]
Did you remember the wine? I knew there was a reason I let you live here.
So were you the best one there? How many people did you save? Did you rock? [JAZZ MUSIC PLAYING ON PIANO.]
[SIGHS.]
[SINGING " YOU'RE NOBOD Y TILL SOMEBOD Y LOVES YOU".]