ER s13e07 Episode Script
Jigsaw
[INDISTINCT P.
A.
ANNOUNCEMENT.]
[PEOPLE CHATTERING.]
MALIK: Yo, Dr.
K.
KOVAC: Hey, hey.
What's up, guys? MARQUEZ: Oh, my God, he's so cute.
Hi, Joe.
KOVAC: Don't let the looks fool you.
He's a tough one.
MARQUEZ: Takes after his mom.
MALIK: Ain't that the truth.
Let me give you a hand, doc.
KOVAC: Thanks.
Babysitter couldn't make it again.
We finally decided to hire a nanny.
My mom raised eight kids all by herself.
- Don't know how she did it.
- She available? PRATT: What about SBO guy? - Waiting on Surgery.
- And your chemo boy in 4? - Oncology about a half hour ago.
Who's this, the new chief of ER? KOVAC: Yep, training him so I can retire early.
Good.
We could use some new blood.
- I'm new.
- You're too old to be new, Gates.
Excuse me, Dr.
Weaver.
Hi, Courtney Brown, Channel 5.
- You got a minute? - No.
Give me a half-inch.
The station loved you and our segment that we did.
They've given us a green light to do some more.
Wow, that sounds cool.
Yeah, I don't think so.
I'm an ER doc, not a TV personality.
Exactly what we're looking for.
Someone real.
You'd be really great.
That piece you did was so good.
You know what? Why don't you take over? Pack all four quadrants and Dawn can help you.
- Wouldn't require much time.
- Gyn has a bed but can't take PID.
FRANK: Dr.
Weaver, Radiology on 2.
- Gotta take this.
I get it, you're swamped.
I'll try later? I think he has Abby's eyes.
- Yeah, and his dad's head.
- Yeah.
- Heh.
- What? He'll grow into it.
[BUZZER SOUNDS.]
[MARQUEZ TALKING INDISTINCTLY.]
Could you guys keep an eye on him for a minute? - Yeah.
- Yeah.
Mr.
Ames? Luka.
Can l? Can I help you with something? No, no.
Got a meeting with Angela Gilliam upstairs.
MAN 1: Give me the other bearing, Steve, would you? MAN 2: That one should fit.
About my appeal.
- She didn't tell you? - No, no.
Yeah.
Had to gather some hospital files.
You're appealing the case? Only if I have to.
You know, a settlement will save the hospital a lot of time and a lot of money.
Look, this hasn't been easy on any of us least of all you, but But what? Maybe it's time to move on.
Put the past behind you.
I couldn't agree more.
[DRILL WHIRRING.]
I'm gonna hop up the stairs.
I'll see you around.
Can you smell my? You can't, but I can.
I can hear now.
I can smell it.
I mean, you can't smell it.
I can smell it.
[MAN COUGHING.]
OLD MAN: I can smell it.
I can smell it.
WOMAN 1: Tight.
Keep that thing pressed to your nose.
WOMAN 2: When? - I wouldn't.
[WOMAN 3 SPEAKING IN SPANISH.]
- Real nice.
- Yeah, it's cool.
[PEOPLE CHATTERING, MAN CHUCKLING.]
[BABY CRYING.]
BO Y: Score.
And the big top winner wins.
Go.
Win.
[MAN COUGHING.]
MAN WITH GLASSES: Hey.
Are those Hot Wheels? - Want one? - Yeah.
I got lots of Hot Wheels too.
What does this one have? I don't know.
Number five.
[MIMICS ENGINE ROARING, CRASHING.]
- Ha-ha-ha.
Beautiful.
- Get off the floor.
Come on.
- Don't make me embarrass you.
- Mom, I'm racing.
MOM: Get over here now.
Come on.
[MAN SCREAMING.]
BARDELLl: Out of the way, man.
Hot oil.
Third-degree burns to the hands.
Let's go, let's go.
MARQUEZ: Exam 3's open.
You can't, but I can, you know.
I can smell them.
I can smell them.
I can smell them.
I can smell them.
I know you're coming for this.
[MAN AND WOMAN ARGUING IN SPANISH.]
[BABY CRYING.]
[SIREN APPROACHING.]
[SNIFFS.]
[ANGRILY.]
Hey! Maybe you haven't noticed, but you got people waiting here.
You actually got any doctors working back there? What is it, golf day? Sir, please sit down.
Don't " sir" me, bitch.
Just let me see a damn doctor.
Calm down or I'll call Security.
Oh, go.
Oh, oh, oh, call them.
- Go ahead.
I'm right here.
SAM: Hey.
[BANGS ON GLASS.]
- What? - Calm down now.
You are not the only patient here, okay? Yeah, I can see that.
I can see that.
- You sign in? - Signed in what? All I got is a little congestion.
You think you morons can handle that? Fill this out.
[BABY CRYING.]
Sit down and shut up.
I'll bring you back in a few minutes.
I just got the flu, for God's sakes.
I wanna apologize in advance for the smell in the break room.
- Luka changed Joe's diaper in there.
- How bad is it? - We got a men's room.
- Not carrots? I hate carrots.
You know, I said I'm sorry.
My babysitter flaked.
I feel bad enough dragging him in here.
PRATT: Hey, has Radiology called back yet? MORRIS: I don't think so.
[IN BRAZILIAN ACCENT.]
Excuse me.
I'm here to see Dr.
Luka Kovac.
SAM: How long have you been congested? I don't know.
Does it matter? SAM: No, I'm just making conversation.
About a month or so.
All right, what have we got? SAM: Temp's 99.
URI symptoms.
The flu.
Deep breath for me, please.
Get that damned thing off of me, it's freezing.
I have to take a listen, sir.
I told you, assholes, it's the flu.
Now, just give me some antibiotics or something and let me out of here.
Listen, Prince Charming quicker we check you out, the quicker you can go.
I need to check the oxygen in your blood.
Part of the exam.
Omit that part.
All right, look.
You have the flu that's an easy fix, then you can go home.
Believe me, I want you to go.
I need you to go.
ABBY: Wow, Rio.
- So Chicago must be a big change.
WOMAN: Mm-hm.
ABBY: Have you been here for a winter yet? No, but I love the cold.
In Brazil, it's always sunshine.
[GIGGLING.]
Jeez, that must have been hard to manage.
Why did you leave your last job? I didn't really like New York.
I wanted a change around the scenery.
Change of scenery.
You wanted change of scenery.
Heh.
Ah.
Sorry.
My English I still make mistakes.
Heh.
[CHUCKLING.]
Great.
Thanks for coming by.
Discipline.
Discipline.
Especially with the little boys.
This is key.
Amway money ran out along with my husband.
So I ask myself, "Jackie, what do you love?" Kids.
Love kids.
Crazy little bastards.
Oh, hey.
Can I smoke in here? It was the best 10 years of my life.
I really loved those kids.
I don't wanna brag, but for all the families I've worked for the kids always end up calling me Mommy by the third week.
[JOE COOING.]
- Ha-ha.
- Okay, great.
Thanks for coming by.
What, you get lost? Seems to be a little problem with your heart.
That from the flu? Normal heart's about the size of a fist.
Yours is twice that big.
I don't think you have flu.
Your congestion, shortness of breath, definitely because of your heart.
Sorry, couldn't find the SonoSite.
How many times do I have to tell you? Lay down, put the gown on.
- I ain't wearing that dress.
- Then lose the shirt.
You gonna at least buy me dinner first? Hey, you get in a lot of fights? Have an accident or something? You got what look like old fractures.
A lot of them.
Few ribs.
Collarbone.
Your arm.
I was an active kid.
SAM: How about the scar and those burns? [BREATHING HEAVILY.]
Yeah, well My pop had a two-pack-a-day habit.
[MACHINE BEEPS.]
[GRUNTS.]
[ULTRASOUND WHOOSHING.]
[MACHINE BEEPING.]
Whoa, he's got a pericardial effusion.
- A what? SAM: Fluid around your heart.
Restricts blood flow, makes it hard for you to breathe.
IV, two of Ativan, set up for pericardiocentesis.
Hang on.
What are you doing? We need to do a procedure where I place a needle into the sac around your heart.
- It's no big deal.
- What? [LAUGHING.]
No.
No way.
- You need this procedure.
- No, I don't.
- Yes, you do.
You could die.
- No.
No, not a chance.
Son of a bitch.
Where'd you get the doctor degree, through the mail? Hey, get out while you can before Kevorkian starts sticking you.
[PHONE RINGS.]
Let me the hell out of here! Now! WEAVER: What can we do for you today, sir? Need my cholesterol prescription filled.
Cholesterol, silent killer.
It's good you're being vigilant.
Dr.
Wong from the Family Medical Center prescribed this for you? - And why didn't you go back to her? - They can't take me for a few months.
Supposed to get a blood test to check my liver You need to see Dr.
Wong.
I'll call up, make sure they know to give you an earlier appointment.
Doc, please.
I don't know when I can take another day off.
I work two jobs.
I got his grandma watching him all the time.
I'll call now and let them know you're coming over.
Hope, please discharge Mr.
Batista and point him to the Family Center.
Hey, Morris, why is Grasso still in Curtain 2? Vertigo guy is still here? You know, mine felt better after meclizine.
OTD in 45 minutes.
It's a first shift in a month he hasn't killed anybody.
- My case is more complicated.
- He have an abnormal neural exam? I just have a clinical hunch, okay? Takes years to develop.
SAM: CT results from Radiology.
RAY: That for your vertigo guy? It's normal, isn't it? And we can all sleep a bit better tonight, can't we? Sam, could you get something from the drug-sample closet? There's limited samples.
Ask an Attending to Dr.
Weaver asked me to get it for one of her patients.
Oh, okay.
No, yeah, it's Batista.
B-A-T-l-S-T-A.
Okay, thank you.
That TV news girl, Courtney Brown, called again.
Whoa, Channel 5 Courtney Brown? What did she want? She offered me a job as a reporter.
What, you? Of course you.
What did you say? I turned it down.
Turned down a chance to be the next Sanjay Gupta? Are you insane, woman? I have no interest in fluff pieces about sunburns and bee stings.
What's wrong? Half the patients that come are fluff.
I'm the king of fluff.
You're the best fluffer in town.
Hey, Hope, you ready for the fecal impaction? HOPE: Sure am.
Ha.
This is an extremely uncommon error.
[JOE CRYING.]
Our personnel were clearly distracted by the ongoing debate.
Reason why ER docs should remain in the ER.
I know ER sounds a lot like O.
R.
, but it's not.
Our guys were there trying to keep you from making mistakes.
Based on the information, our decision to operate was correct.
You know what, you didn't have sufficient information because you didn't allow us to complete an evaluation.
This isn't a witch-hunt.
We're here to learn from our mistakes and improve.
You mean, their mistakes.
Okay, let's not forget that we're on the same team here.
DUBENKO: Oh, Dr.
Gates, come on in.
- You missed the case presentation.
- Sorry, I had a patient.
You know, sorry.
I just gotta No, that's okay.
Timely enough, Dr.
Gates.
No need to sit.
Come on down.
Why don't you tell us what the differential diagnosis was when this patient presented? Um Triple A was on the top of our list but there were other possibilities.
Should have stayed a Resident.
No responsibilities, just heal them and deal them.
That was the life.
Morris? - Can I tell you something as a friend? - Hmm.
Sometimes you are such a little bitch.
You make three times as much as I do.
And for what? To give orders instead of take them? Boo-hoo for you.
Mr.
Batista.
We got a double coming.
Might wanna jump on.
I'll be right there, Dr.
Morris.
Mr.
Batista, wait.
[HOPE PANTING.]
I called the Family Care Center.
They can't take you for a month.
I'm very sorry about all that.
The system's Well, it needs work.
Lovastatin.
Thirty pills, 20 milligrams each.
Shh.
This should hold you till your next appointment.
- Thanks a lot.
HARMS: I got a present for you.
This is us, Hope.
Unidentified male, early 20s, altercation on a bus blunt trauma to the chest and face.
Ray, Malik, you take this.
Trauma 2 is open.
Sam, Hope, you're with me.
He's tachy in the 120s, resps in the 30s, BP, 104/56.
CBC, IV, type and cross.
Let's go.
Fred Douglas, 38, blunt trauma to the face with epistaxis.
- Son of a bitch broke my nose.
- Keep pressure.
He was yelling at some lady.
I tell him to shut up, next thing you know, he's throwing punches.
- How you doing in there, Ray? RAY: I'm doing good.
MALIK: Could probably use a hand when you're done.
Guy I got in a fight with, I didn't hurt him bad, did I? SAM: HemoCue's 12.
8.
First, we look for an obvious source of bleeding that can be cauterized.
Is it broken, doc? It sure fee [SNEEZES.]
Ugh.
God bless you.
Snuck up on me.
Sorry.
You need a definitive triple A diagnosis [JOE CRYING.]
before committing an unstable patient to major surgery.
Mortality ruptured triple A, - We don't have time for tests.
- Ultrasound can be done at the bedside.
Theoretically.
Not in this ER.
Every textbook and print says this patient Ultrasound in ER is new, not in every textbook.
- Studies show it's very accurate.
- Ignore experience because a new toy? People die with delays.
Valentine paper, 1993 found that most patients without triple A's still need surgery for one thing Most, not all.
With severe heart failure, surgery can be fatal.
Guy's lucky all you did was torch him.
You could've killed him.
Okay.
What is your experience in the ER with bedside ultrasound? It's been going on for a few years.
He's cute, but I hear he lives with somebody.
Really? I think he has a kid.
- With final radiology interpretation, no significant clinical disagreements.
What about for a triple A, specifically? Uh Heh.
I don't know, exactly.
Though finding a gallstone is one thing, ruptured aneurysm, quite another.
Well, if we'd seen a normal aorta with an enlarged liver we would've saved the guy the risk of surgery.
- You couldn't do it in a reasonable time.
- We weren't given a reasonable time.
He was unstable, surgery was necessary.
- Lighting the guy on fire was necessary? - A Bovie wasn't grounded.
- Whose fault? - Yours.
Shouldn't even been in O.
R.
You were there being a pain in the ass.
- We have protocols.
You interfered.
- Our duty doesn't end.
Okay, okay.
That's enough.
That's enough.
Thank you, Dr.
Gates.
I think we can all see what the real problem is here.
Providing the best care requires communicating openly.
And when we fail to do that, lives are lost.
I think that's something we can all learn from today's M and M.
ABBY: Crenshaw is such a little prick.
You know what? I bet I could take him too.
I definitely think I could take him, and you could kick his ass.
ANGELA: Luka.
- You're scaring me.
I was looking for you.
Sorry I didn't get back earlier.
- Angela, you remember Abby? - Sure.
Nice to see you back at work.
Nice to be back.
So I probably should have warned you Curtis Ames was coming in.
Okay, what's all this about settlement? There is no settlement.
We agreed to the meeting as a show of good faith in case we went back to trial.
But don't worry, the appeal's never gonna happen.
Ames can't even find a lawyer to take the case.
- We're not settling.
It's over.
- Good.
All right, what do we got? Okay, hypotensive secondary to what looks like a traumatic pericardial effusion.
Wow, guy's got a lot of fluid around his heart.
Looks like I'm gonna do a pericardiocentesis.
BP's still dropping, 88/52.
- So weird, I had one this morning.
- Okay, Malik, set me up.
- How's your guy? MORRIS: Just a bloody nose.
You say there's something wrong with my heart? MALIK: He's awake.
Sir, I'm Dr.
Morris, Attending physician.
Wait a minute, it's you, from this morning.
RAY: You know him? - Yeah No, no.
You were here earlier? WILLIS: No, I wasn't.
- Hey, Sam? - Yeah? MORRIS: He's our AMA patient from this morning, right? Yeah, the flu jerk.
I don't know what you people are talking about.
I don't have the flu.
And I've never been here before.
[SIREN WAILING.]
Joe.
Hey, what's it gonna be? Good-Iooking Brazilian or big mean Russian? Ooh.
Joe [SPEAKING IN CROATIAN.]
[CHUCKLES.]
KOVAC: Okay.
Go home.
ABBY: Say bye.
KOVAC: Bye.
[TAPPING CUP.]
RAY: We use an ultrasound to see while we insert the needle into the pericardial sac to drain the blood.
You use sound to see? That's fascinating.
Just like bats and dolphins.
[SCOFFS.]
It'll release the pressure on your heart, make it easier to breathe.
And I won't feel a thing? Not a thing.
- Can I watch? - Yeah, sure.
Okay, cool.
Oh, come on.
This morning, bats-and-dolphins here was ready to rip my head off.
- What are you trying to pull, buddy? - Why is he so angry? Prep his chest, have two of Versed ready.
Mr.
Payton, we'll be right back.
Morris, can we talk? Morris.
I don't know what his game is His game is he's kooky from a blow to his head.
He could be amnestic.
He's gotta be on something.
He's different.
Give the guy a break.
He got his ass kicked.
He didn't want that procedure this morning.
Maybe he's really pissed off at you, Archie.
Wouldn't be the first time.
Now, I know this may sound a little corny but I always catch more flies with honey, you know what I mean? That's good.
That's good, Ray.
I like that approach.
You'll make a great Attending someday, my man.
I'm sorry, I know my wallet's in here somewhere.
[JOE CRIES.]
- Damn it.
AMES: I got that.
- And can I get a Polish please? - No, that's okay.
Don't worry.
I insist, really.
It's not necessary, really.
Well, you got your hands full.
It's the least I could do.
It's just a hot dog.
My mama taught me random acts of kindness make the world a better place.
Well, I can't argue with that.
Thank you.
- What is he, about 6 months? - Five and a half.
- He's really cute.
- He's got pipes you wouldn't believe.
Are you driving your mom crazy? No, no.
[CHILDREN YELLING, CHATTERING.]
Hoo.
Hoo.
Frog.
Ribbit.
This one yours? Here you go.
- Excuse me, Dr.
Weaver? - Yeah.
Something is weighing on my heart and I just can't take it anymore.
What's the problem? I gave Oscar Batista Lovastatin samples.
That sweet, hard-working man, I was afraid he would stop taking pills and come back here with a heart attack or stroke - Hope.
- That little boy.
Reminded me how moved I was by your piece.
- Thought some act of kindness might - Okay, okay, okay.
- And please forgive me, doctor - Okay, okay, stop.
You did a good thing.
Really.
There might be hope for you, Hope.
You told me those drug samples were for Dr.
Weaver's patient.
Well, they were, technically.
Well, technically, you lied to me.
There are rules for breaking the rules, and rule number one is that you never, ever lie to the nurses, you got me? I'm so sorry.
AMES: Fell off a ladder at work.
Dude wasn't paying attention, so I had to pay the price.
Oh, sounds like a dangerous job.
No, carpenter.
It's tough doing it with one arm, though.
Well, sprains heal pretty quickly.
Yeah, that's what they told me at the hospital.
Uh I'm headed for the red line.
Oh, I'm headed this way.
Well - Nice to meet you.
- Ha-ha.
You too.
- And thank you for the hot dog.
- It's my pleasure.
Catch you later, Joe.
Ha-ha.
Hey, any messages for me yet, Frank? No, Morris, the TV-producer lady has not called back yet.
You ask me one more time, I'm gonna slap you so hard you turn brunette.
Have you got that? - Position's been filled.
- What position? Stop calling the station.
I'm getting complaints.
Oh, that position, right.
They filled it, huh? - Mm-hm.
- Who did they find so fast? - Me.
- You? I thought you turned it down.
Yeah, well, I changed my mind.
Figured it was about time someone put something worthwhile on television.
[BUZZER SOUNDS.]
So, Smitty, how long you had the rash? About two weeks now.
- Got any food allergies? - No.
- You on any medications? - Just my blood-pressure pills.
All right, come on.
Have a seat.
What kind of pills? [SIGHS.]
Right.
Oh, you see, that's the problem.
Rash is a common reaction to enalapril.
Who prescribed these? Doc up at the clinic put me on them about 10 years ago.
This and something else.
- Ten years ago? Who gave you these? - Mm-hm.
See, my man, T-bone.
You know T.
Smitty, you can't take other people's medications, man.
It's not safe.
- Everybody does it.
- Everybody who? Up at First Mission Baptist, Pastor Watkins does a drug-exchange program.
You come up there sometime, man gives a powerful Okay, hold on, hold on.
He does a drug-exchange program? Hell, yeah.
I ain't got insurance.
You know how much this stuff costs? [EXHALES.]
[DOOR OPENS.]
You can't possibly think ultrasound was contraindicated.
- I do if it can't be done immediately.
- Could've told me before M and M.
Didn't realize I had to point out the obvious.
I can't win with you.
- Oh.
Finally, we agree on something.
- Finally.
- Yes.
- Yes.
Don't take piss out of me.
- Piss? Piss? - Yes.
Yes.
Yup, you've got a nice fluid pocket.
This is gonna be a snap.
Sam, draw up some 1 percent lido.
Whoa.
MARQUEZ: You're gonna feel a pinch.
- Okay, before I start, just a few things.
BO Y: I don't want a shot.
- Main risks here, bleeding and infection.
You could infect my heart? - Sterile technique makes it unlikely.
MOM: Mickey, calm down.
BO Y: No.
Aah.
Look, what about bleeding? I have trepidation about bleeding.
Well, it's only a minor risk, because we're using such a small needle.
Well, not so small, but thin.
And you'll be all numbed up so you won't feel a thing.
MARQUEZ: Relax.
BO Y: No, no.
Stop it.
Okey-dokey, let's do this.
[BO Y SCREAMING.]
Get that thing away from me, you clown.
I told you, I don't want that.
- You agreed to the procedure.
- Screw that.
Mr.
Payton.
And stop calling me that.
My name's Clyde Sandberg.
You people got short-term memory loss or something? Huh? - You ambushed me.
- You were spewing absurdities.
- Do you not like me? - You're a wanker.
- A wanker.
Ouch.
- Yeah, you're cocky, arrogant.
- And you're not smooth as you think.
- I'm not? - No, you're not.
- I never said I was.
[BOTH MOANING SOFTLY.]
[CLATTERING.]
- Mm.
- Mm.
I called the other night and a woman answered.
Yeah, I can explain that.
Now would be a good time.
[TABLE SCRAPING.]
[NEELA AND GATES MOANING.]
Here, here, bats-and-dolphins guy, I figured it out.
- It's DID.
- What? Dissociative Identity Disorder.
Multiple personalities? Psych make that diagnosis? No, I paged them.
They haven't come.
So this is based off of what? Your extensive psychiatric expertise? No, he's a classic presentation.
Old abuse injuries, keeps changing his name.
Maybe it's you that needs a psych evaluation.
No, I'm serious, Ray.
We have to double-doctor this guy.
Listen, he keeps refusing treatment, that effusion will kill him.
Who knows how long Psych will take? By the time their Resident sees him they present to the Attending, could be hours.
Double-doctoring, that's a big deal.
Can't we treat with NSAIDs and steroids? He's refusing vital treatment.
And that is grounds for a double-doctor.
Come on, get with me here.
- What, so I'm back on the case now? - Yeah.
Huh.
Look, I'll tell you what.
I'll talk to him.
I'll try and get some sort of read, but maybe you should hang back.
You already pissed him off enough today.
So I have a few questions for you.
Can you tell me what day it is? [SIGHS.]
Thursday.
Month and year? You know, they got this new thing out called a calendar.
My freaking God.
November, 2006.
- Do you know where you are? - What is this, Romper Room? I see stupid and retard and jerk-off.
I'm at County General Hospital.
RAY: I'm not double-doctoring.
- He's gonna get worse.
He's hypotensive with reduced cardiac output.
He hates doctors, especially you.
You wanna tie him, stick a needle in his chest? - Lf it'll save his life, hell, yeah.
- Ha-ha.
I am out, Archie.
Fine, I'll get somebody else.
Hey, Pratt.
No, no, no.
Hasta la bye-bye.
Pratt, I need you to sign off on a double-doctor.
[SIGHS.]
- Got a foster kid? - No, he's a competent adult.
Got pericardial effusion and doesn't want treatment.
Morris wants to get medieval because he thinks - I think he's DID.
- Multiple personalities.
Yeah, I know.
What did Psych say? They're MIA.
You know that multiple personality Dissociative Identity Disorder.
- Yeah, some docs don't think it exists.
- There's ton of literature to support it.
- Okay, his vitals? - Systolic's holding in the 90s.
- And mental status? - Alert and oriented.
Tox screen and CT? Clear.
Gotta treat him conservatively.
Wait for Psych, it's their call.
You want me to be thorough.
That's what I'm doing.
Pratt, listen to me for one second.
Pratt.
NEELA: If patient presents within a week of surgery, it's considered bounce-back.
Make sure bounce-backs Hey, can I speak to you for a sec? Wound seroma.
Removing the staples and packing the dermis.
I wasn't actually talking to you.
Oh.
Um Okay, go ahead.
I'll just get started.
So how's Surgery treating you? Like a stepchild.
Radiology's looking better every day.
It'll be over soon enough.
I hated my surgical rotation, anyway.
So do you like hockey? Tonsil or ice? [CHUCKLING.]
- Ice.
- Oh.
Mm.
Too bad.
But, yeah, I'll settle for a Hawks game.
[BOTH CHUCKLE.]
He's still refusing treatment? Last BP was 84/50 and he's developed pulsus paradoxus.
I found his old file.
Willis Payton is his real name, probably be the host personality.
This Clyde character must be one of his alters.
He was here a bunch of times between '88 and '96.
Foster kid, abuse-related injuries, some bad ones too.
It's classic DID history.
Psych's still a no-show? [SAM SIGHS.]
I know everybody down here thinks I'm a joke.
You know, if Pratt said DID, he'd be a genius.
[SCOFFS.]
But I know that I'm right about this.
And all I can do is suck on it and watch this guy die.
You did what you could.
And you're not a joke, Archie.
You're an Attending.
[SOFTLY.]
Thank you.
MAN: Was a time when that mountain seemed so high like it stretched up to the pearly gates themselves.
[PEOPLE AGREEING.]
Promised land seemed like an idea, like no matter how hard we worked it was only sand between our fingers.
[PHONE BEEPS.]
But we're still here.
Proud and strong, Lord have mercy, we're still here.
But we got a whole lot of work to do.
Because the more things change, the more they stay the same.
Young brother in the back.
You're new.
Stand up and introduce yourself.
No, no, you.
Ha-ha-ha.
[CHUCKLES.]
Evening, everyone.
I'm Greg Pratt.
Welcome, brother Pratt.
Come up front.
Nice to see young folk in the evening service, ain't it? [CROWD AGREEING.]
Your heart's getting worse, you know.
[SIGHS.]
Here we go again.
No.
You need me to spell it? If you keep refusing treatment, it's gonna go down one of two ways.
One, doctors are gonna come in here, tie you down and do the procedure.
They can't touch me, I got rights.
Or two, we get to watch you die.
Fun for you.
There's a third option.
You give consent, we fix your heart and you go home.
All we wanna do is help.
Yeah, you've been loads of help so far.
- I know you're scared.
- No, I ain't scared of nothing.
I know you've been hurt a lot.
But you are safe here.
I know you don't wanna trust us, but you can.
I promise.
[LIGHT BUZZING.]
[SOFTLY.]
I was Was Was I sleeping? No.
I lost time.
I lost time again.
[SIGHS THEN SNIFFS.]
Willis? Yeah? Clyde's been giving us a hard time.
Oh.
I thought he was gone.
You know about Clyde? Yeah.
My friends told me about him.
He's very negative.
Well, Clyde doesn't want us to help you.
So all we could do was give you some medicine but that's not working too well.
Um Wha? Can you? Can you still fix me? Willis, I need Clyde's permission.
I can't make him do anything.
I can't.
We can't start and stop again.
We're running out of time.
No.
No, no, no.
No.
[SHOUTING.]
Willis.
Damn it, let me talk to Clyde right now.
Do not make me hurt you.
Let me talk to Clyde.
How many times I gotta tell you to get off me, bitch? Huh? How many times? Huh? I saw Willis.
- He's letting us do the procedure.
- He's a pansy.
Yeah, well, he's brave enough to let us stick a needle in his heart.
Piss off, bitch.
Fine.
You be a tough guy all the way to your funeral.
I'm done.
Hey.
[EXHALES.]
You stick my heart, that means I get out of here, right? Yup.
Do it.
I told you, I ain't scared of nothing.
The drug-exchange program is only for people who have prescriptions but can't afford the drugs.
Smitty's prescription was 10 years old, and he had enalapril.
Enalapril is not the first drug of choice for black folks with high blood pressure.
Look, I suggest that you start an exercise program.
Get your congregation to stop eating salt and fried foods and start exercising.
Trust me, you'll do a whole lot more good.
We don't just help people with high blood pressure.
We have diabetics, asthmatics, you name it.
Look, what you're doing is dangerous, okay? Not to mention illegal.
[SIGHS.]
I have an obligation to this community, Dr.
Pratt.
These people are shackled by a system over which they have no control.
- Yeah.
- The one thing I will not do is nothing.
Excuse me, Dr.
Morris? - Can I ask your advice on something? - Yeah.
I lied to Samantha about something, and now she's really steamed.
Oh, bad move.
Piss one nurse off, piss them all off, like the Mafia.
You know, whenever I'm in a precarious situation I always ask myself, "What would Jesus do?" Right.
What would Jesus do if the nurses hated him? Well, he would do the right thing, of course.
That's the problem.
See, I thought I was doing the right thing.
I guess I just did it the wrong way.
Hey, the story of my life.
You know, sometimes it doesn't matter how much we kick and scream.
Even when we're right.
The prophet is without honor in his own land.
Matthew 13:54.
Oh, I love that one.
Big Matthew fan.
[LAUGHS.]
You have a good night, Dr.
Morris.
Feeling better? Drained half a liter of fluid from around your heart.
Blood pressure and pulse are back to normal.
Soon as a bed opens up, we'll get you upstairs to a room.
So you're doing great.
[SOFTLY.]
You got my glasses? Let me check.
Yeah.
[CHUCKLES.]
Okay.
[SNIFFLES.]
That kid gonna be okay? Who? MORRIS: Yeah.
I'm sure he is.
Looks like he's leaving.
He was racing a Hot Wheels.
His mom, she was mean.
[SNIFFLING.]
Um Willis? [CHUCKLES.]
My name's Andre.
I like Hot Wheels.
I wish his mom wasn't so mean.
Hey, hey.
[VOICE BREAKING.]
Don't tell my dad I'm here, okay? He can be pretty mean too.
[CRYING.]
[QUIETLY.]
Yeah.
Your secret's safe with me.
Okay? It's kind of dark in here.
You're not gonna leave, are you? No.
No way, buddy, no.
I'm here all night.
[CHUCKLES.]
That's good.
[PULLS UP CHAIR.]
[CLEARS THROAT.]
So, what kind of Hot Wheels you got? All kinds.
I collect them.
Yeah? I used to collect them too.
[CHUCKLES.]
What kind you got? I used to have a '57 Chevy.
- Heh.
I got that one.
- You got that.
Shelby Cobra.
Got it.
Okay, all right.
'65 Mustang Fastback.
Heh.
I got two.
- You got two? - Yeah.
[LAUGHS.]
Wow.
I used to have three, but I gave one to my friend.
You'll have to give one to me.
I don't think I have mine anymore.
Okay, I'll give it to you.
What else did you have?
A.
ANNOUNCEMENT.]
[PEOPLE CHATTERING.]
MALIK: Yo, Dr.
K.
KOVAC: Hey, hey.
What's up, guys? MARQUEZ: Oh, my God, he's so cute.
Hi, Joe.
KOVAC: Don't let the looks fool you.
He's a tough one.
MARQUEZ: Takes after his mom.
MALIK: Ain't that the truth.
Let me give you a hand, doc.
KOVAC: Thanks.
Babysitter couldn't make it again.
We finally decided to hire a nanny.
My mom raised eight kids all by herself.
- Don't know how she did it.
- She available? PRATT: What about SBO guy? - Waiting on Surgery.
- And your chemo boy in 4? - Oncology about a half hour ago.
Who's this, the new chief of ER? KOVAC: Yep, training him so I can retire early.
Good.
We could use some new blood.
- I'm new.
- You're too old to be new, Gates.
Excuse me, Dr.
Weaver.
Hi, Courtney Brown, Channel 5.
- You got a minute? - No.
Give me a half-inch.
The station loved you and our segment that we did.
They've given us a green light to do some more.
Wow, that sounds cool.
Yeah, I don't think so.
I'm an ER doc, not a TV personality.
Exactly what we're looking for.
Someone real.
You'd be really great.
That piece you did was so good.
You know what? Why don't you take over? Pack all four quadrants and Dawn can help you.
- Wouldn't require much time.
- Gyn has a bed but can't take PID.
FRANK: Dr.
Weaver, Radiology on 2.
- Gotta take this.
I get it, you're swamped.
I'll try later? I think he has Abby's eyes.
- Yeah, and his dad's head.
- Yeah.
- Heh.
- What? He'll grow into it.
[BUZZER SOUNDS.]
[MARQUEZ TALKING INDISTINCTLY.]
Could you guys keep an eye on him for a minute? - Yeah.
- Yeah.
Mr.
Ames? Luka.
Can l? Can I help you with something? No, no.
Got a meeting with Angela Gilliam upstairs.
MAN 1: Give me the other bearing, Steve, would you? MAN 2: That one should fit.
About my appeal.
- She didn't tell you? - No, no.
Yeah.
Had to gather some hospital files.
You're appealing the case? Only if I have to.
You know, a settlement will save the hospital a lot of time and a lot of money.
Look, this hasn't been easy on any of us least of all you, but But what? Maybe it's time to move on.
Put the past behind you.
I couldn't agree more.
[DRILL WHIRRING.]
I'm gonna hop up the stairs.
I'll see you around.
Can you smell my? You can't, but I can.
I can hear now.
I can smell it.
I mean, you can't smell it.
I can smell it.
[MAN COUGHING.]
OLD MAN: I can smell it.
I can smell it.
WOMAN 1: Tight.
Keep that thing pressed to your nose.
WOMAN 2: When? - I wouldn't.
[WOMAN 3 SPEAKING IN SPANISH.]
- Real nice.
- Yeah, it's cool.
[PEOPLE CHATTERING, MAN CHUCKLING.]
[BABY CRYING.]
BO Y: Score.
And the big top winner wins.
Go.
Win.
[MAN COUGHING.]
MAN WITH GLASSES: Hey.
Are those Hot Wheels? - Want one? - Yeah.
I got lots of Hot Wheels too.
What does this one have? I don't know.
Number five.
[MIMICS ENGINE ROARING, CRASHING.]
- Ha-ha-ha.
Beautiful.
- Get off the floor.
Come on.
- Don't make me embarrass you.
- Mom, I'm racing.
MOM: Get over here now.
Come on.
[MAN SCREAMING.]
BARDELLl: Out of the way, man.
Hot oil.
Third-degree burns to the hands.
Let's go, let's go.
MARQUEZ: Exam 3's open.
You can't, but I can, you know.
I can smell them.
I can smell them.
I can smell them.
I can smell them.
I know you're coming for this.
[MAN AND WOMAN ARGUING IN SPANISH.]
[BABY CRYING.]
[SIREN APPROACHING.]
[SNIFFS.]
[ANGRILY.]
Hey! Maybe you haven't noticed, but you got people waiting here.
You actually got any doctors working back there? What is it, golf day? Sir, please sit down.
Don't " sir" me, bitch.
Just let me see a damn doctor.
Calm down or I'll call Security.
Oh, go.
Oh, oh, oh, call them.
- Go ahead.
I'm right here.
SAM: Hey.
[BANGS ON GLASS.]
- What? - Calm down now.
You are not the only patient here, okay? Yeah, I can see that.
I can see that.
- You sign in? - Signed in what? All I got is a little congestion.
You think you morons can handle that? Fill this out.
[BABY CRYING.]
Sit down and shut up.
I'll bring you back in a few minutes.
I just got the flu, for God's sakes.
I wanna apologize in advance for the smell in the break room.
- Luka changed Joe's diaper in there.
- How bad is it? - We got a men's room.
- Not carrots? I hate carrots.
You know, I said I'm sorry.
My babysitter flaked.
I feel bad enough dragging him in here.
PRATT: Hey, has Radiology called back yet? MORRIS: I don't think so.
[IN BRAZILIAN ACCENT.]
Excuse me.
I'm here to see Dr.
Luka Kovac.
SAM: How long have you been congested? I don't know.
Does it matter? SAM: No, I'm just making conversation.
About a month or so.
All right, what have we got? SAM: Temp's 99.
URI symptoms.
The flu.
Deep breath for me, please.
Get that damned thing off of me, it's freezing.
I have to take a listen, sir.
I told you, assholes, it's the flu.
Now, just give me some antibiotics or something and let me out of here.
Listen, Prince Charming quicker we check you out, the quicker you can go.
I need to check the oxygen in your blood.
Part of the exam.
Omit that part.
All right, look.
You have the flu that's an easy fix, then you can go home.
Believe me, I want you to go.
I need you to go.
ABBY: Wow, Rio.
- So Chicago must be a big change.
WOMAN: Mm-hm.
ABBY: Have you been here for a winter yet? No, but I love the cold.
In Brazil, it's always sunshine.
[GIGGLING.]
Jeez, that must have been hard to manage.
Why did you leave your last job? I didn't really like New York.
I wanted a change around the scenery.
Change of scenery.
You wanted change of scenery.
Heh.
Ah.
Sorry.
My English I still make mistakes.
Heh.
[CHUCKLING.]
Great.
Thanks for coming by.
Discipline.
Discipline.
Especially with the little boys.
This is key.
Amway money ran out along with my husband.
So I ask myself, "Jackie, what do you love?" Kids.
Love kids.
Crazy little bastards.
Oh, hey.
Can I smoke in here? It was the best 10 years of my life.
I really loved those kids.
I don't wanna brag, but for all the families I've worked for the kids always end up calling me Mommy by the third week.
[JOE COOING.]
- Ha-ha.
- Okay, great.
Thanks for coming by.
What, you get lost? Seems to be a little problem with your heart.
That from the flu? Normal heart's about the size of a fist.
Yours is twice that big.
I don't think you have flu.
Your congestion, shortness of breath, definitely because of your heart.
Sorry, couldn't find the SonoSite.
How many times do I have to tell you? Lay down, put the gown on.
- I ain't wearing that dress.
- Then lose the shirt.
You gonna at least buy me dinner first? Hey, you get in a lot of fights? Have an accident or something? You got what look like old fractures.
A lot of them.
Few ribs.
Collarbone.
Your arm.
I was an active kid.
SAM: How about the scar and those burns? [BREATHING HEAVILY.]
Yeah, well My pop had a two-pack-a-day habit.
[MACHINE BEEPS.]
[GRUNTS.]
[ULTRASOUND WHOOSHING.]
[MACHINE BEEPING.]
Whoa, he's got a pericardial effusion.
- A what? SAM: Fluid around your heart.
Restricts blood flow, makes it hard for you to breathe.
IV, two of Ativan, set up for pericardiocentesis.
Hang on.
What are you doing? We need to do a procedure where I place a needle into the sac around your heart.
- It's no big deal.
- What? [LAUGHING.]
No.
No way.
- You need this procedure.
- No, I don't.
- Yes, you do.
You could die.
- No.
No, not a chance.
Son of a bitch.
Where'd you get the doctor degree, through the mail? Hey, get out while you can before Kevorkian starts sticking you.
[PHONE RINGS.]
Let me the hell out of here! Now! WEAVER: What can we do for you today, sir? Need my cholesterol prescription filled.
Cholesterol, silent killer.
It's good you're being vigilant.
Dr.
Wong from the Family Medical Center prescribed this for you? - And why didn't you go back to her? - They can't take me for a few months.
Supposed to get a blood test to check my liver You need to see Dr.
Wong.
I'll call up, make sure they know to give you an earlier appointment.
Doc, please.
I don't know when I can take another day off.
I work two jobs.
I got his grandma watching him all the time.
I'll call now and let them know you're coming over.
Hope, please discharge Mr.
Batista and point him to the Family Center.
Hey, Morris, why is Grasso still in Curtain 2? Vertigo guy is still here? You know, mine felt better after meclizine.
OTD in 45 minutes.
It's a first shift in a month he hasn't killed anybody.
- My case is more complicated.
- He have an abnormal neural exam? I just have a clinical hunch, okay? Takes years to develop.
SAM: CT results from Radiology.
RAY: That for your vertigo guy? It's normal, isn't it? And we can all sleep a bit better tonight, can't we? Sam, could you get something from the drug-sample closet? There's limited samples.
Ask an Attending to Dr.
Weaver asked me to get it for one of her patients.
Oh, okay.
No, yeah, it's Batista.
B-A-T-l-S-T-A.
Okay, thank you.
That TV news girl, Courtney Brown, called again.
Whoa, Channel 5 Courtney Brown? What did she want? She offered me a job as a reporter.
What, you? Of course you.
What did you say? I turned it down.
Turned down a chance to be the next Sanjay Gupta? Are you insane, woman? I have no interest in fluff pieces about sunburns and bee stings.
What's wrong? Half the patients that come are fluff.
I'm the king of fluff.
You're the best fluffer in town.
Hey, Hope, you ready for the fecal impaction? HOPE: Sure am.
Ha.
This is an extremely uncommon error.
[JOE CRYING.]
Our personnel were clearly distracted by the ongoing debate.
Reason why ER docs should remain in the ER.
I know ER sounds a lot like O.
R.
, but it's not.
Our guys were there trying to keep you from making mistakes.
Based on the information, our decision to operate was correct.
You know what, you didn't have sufficient information because you didn't allow us to complete an evaluation.
This isn't a witch-hunt.
We're here to learn from our mistakes and improve.
You mean, their mistakes.
Okay, let's not forget that we're on the same team here.
DUBENKO: Oh, Dr.
Gates, come on in.
- You missed the case presentation.
- Sorry, I had a patient.
You know, sorry.
I just gotta No, that's okay.
Timely enough, Dr.
Gates.
No need to sit.
Come on down.
Why don't you tell us what the differential diagnosis was when this patient presented? Um Triple A was on the top of our list but there were other possibilities.
Should have stayed a Resident.
No responsibilities, just heal them and deal them.
That was the life.
Morris? - Can I tell you something as a friend? - Hmm.
Sometimes you are such a little bitch.
You make three times as much as I do.
And for what? To give orders instead of take them? Boo-hoo for you.
Mr.
Batista.
We got a double coming.
Might wanna jump on.
I'll be right there, Dr.
Morris.
Mr.
Batista, wait.
[HOPE PANTING.]
I called the Family Care Center.
They can't take you for a month.
I'm very sorry about all that.
The system's Well, it needs work.
Lovastatin.
Thirty pills, 20 milligrams each.
Shh.
This should hold you till your next appointment.
- Thanks a lot.
HARMS: I got a present for you.
This is us, Hope.
Unidentified male, early 20s, altercation on a bus blunt trauma to the chest and face.
Ray, Malik, you take this.
Trauma 2 is open.
Sam, Hope, you're with me.
He's tachy in the 120s, resps in the 30s, BP, 104/56.
CBC, IV, type and cross.
Let's go.
Fred Douglas, 38, blunt trauma to the face with epistaxis.
- Son of a bitch broke my nose.
- Keep pressure.
He was yelling at some lady.
I tell him to shut up, next thing you know, he's throwing punches.
- How you doing in there, Ray? RAY: I'm doing good.
MALIK: Could probably use a hand when you're done.
Guy I got in a fight with, I didn't hurt him bad, did I? SAM: HemoCue's 12.
8.
First, we look for an obvious source of bleeding that can be cauterized.
Is it broken, doc? It sure fee [SNEEZES.]
Ugh.
God bless you.
Snuck up on me.
Sorry.
You need a definitive triple A diagnosis [JOE CRYING.]
before committing an unstable patient to major surgery.
Mortality ruptured triple A, - We don't have time for tests.
- Ultrasound can be done at the bedside.
Theoretically.
Not in this ER.
Every textbook and print says this patient Ultrasound in ER is new, not in every textbook.
- Studies show it's very accurate.
- Ignore experience because a new toy? People die with delays.
Valentine paper, 1993 found that most patients without triple A's still need surgery for one thing Most, not all.
With severe heart failure, surgery can be fatal.
Guy's lucky all you did was torch him.
You could've killed him.
Okay.
What is your experience in the ER with bedside ultrasound? It's been going on for a few years.
He's cute, but I hear he lives with somebody.
Really? I think he has a kid.
- With final radiology interpretation, no significant clinical disagreements.
What about for a triple A, specifically? Uh Heh.
I don't know, exactly.
Though finding a gallstone is one thing, ruptured aneurysm, quite another.
Well, if we'd seen a normal aorta with an enlarged liver we would've saved the guy the risk of surgery.
- You couldn't do it in a reasonable time.
- We weren't given a reasonable time.
He was unstable, surgery was necessary.
- Lighting the guy on fire was necessary? - A Bovie wasn't grounded.
- Whose fault? - Yours.
Shouldn't even been in O.
R.
You were there being a pain in the ass.
- We have protocols.
You interfered.
- Our duty doesn't end.
Okay, okay.
That's enough.
That's enough.
Thank you, Dr.
Gates.
I think we can all see what the real problem is here.
Providing the best care requires communicating openly.
And when we fail to do that, lives are lost.
I think that's something we can all learn from today's M and M.
ABBY: Crenshaw is such a little prick.
You know what? I bet I could take him too.
I definitely think I could take him, and you could kick his ass.
ANGELA: Luka.
- You're scaring me.
I was looking for you.
Sorry I didn't get back earlier.
- Angela, you remember Abby? - Sure.
Nice to see you back at work.
Nice to be back.
So I probably should have warned you Curtis Ames was coming in.
Okay, what's all this about settlement? There is no settlement.
We agreed to the meeting as a show of good faith in case we went back to trial.
But don't worry, the appeal's never gonna happen.
Ames can't even find a lawyer to take the case.
- We're not settling.
It's over.
- Good.
All right, what do we got? Okay, hypotensive secondary to what looks like a traumatic pericardial effusion.
Wow, guy's got a lot of fluid around his heart.
Looks like I'm gonna do a pericardiocentesis.
BP's still dropping, 88/52.
- So weird, I had one this morning.
- Okay, Malik, set me up.
- How's your guy? MORRIS: Just a bloody nose.
You say there's something wrong with my heart? MALIK: He's awake.
Sir, I'm Dr.
Morris, Attending physician.
Wait a minute, it's you, from this morning.
RAY: You know him? - Yeah No, no.
You were here earlier? WILLIS: No, I wasn't.
- Hey, Sam? - Yeah? MORRIS: He's our AMA patient from this morning, right? Yeah, the flu jerk.
I don't know what you people are talking about.
I don't have the flu.
And I've never been here before.
[SIREN WAILING.]
Joe.
Hey, what's it gonna be? Good-Iooking Brazilian or big mean Russian? Ooh.
Joe [SPEAKING IN CROATIAN.]
[CHUCKLES.]
KOVAC: Okay.
Go home.
ABBY: Say bye.
KOVAC: Bye.
[TAPPING CUP.]
RAY: We use an ultrasound to see while we insert the needle into the pericardial sac to drain the blood.
You use sound to see? That's fascinating.
Just like bats and dolphins.
[SCOFFS.]
It'll release the pressure on your heart, make it easier to breathe.
And I won't feel a thing? Not a thing.
- Can I watch? - Yeah, sure.
Okay, cool.
Oh, come on.
This morning, bats-and-dolphins here was ready to rip my head off.
- What are you trying to pull, buddy? - Why is he so angry? Prep his chest, have two of Versed ready.
Mr.
Payton, we'll be right back.
Morris, can we talk? Morris.
I don't know what his game is His game is he's kooky from a blow to his head.
He could be amnestic.
He's gotta be on something.
He's different.
Give the guy a break.
He got his ass kicked.
He didn't want that procedure this morning.
Maybe he's really pissed off at you, Archie.
Wouldn't be the first time.
Now, I know this may sound a little corny but I always catch more flies with honey, you know what I mean? That's good.
That's good, Ray.
I like that approach.
You'll make a great Attending someday, my man.
I'm sorry, I know my wallet's in here somewhere.
[JOE CRIES.]
- Damn it.
AMES: I got that.
- And can I get a Polish please? - No, that's okay.
Don't worry.
I insist, really.
It's not necessary, really.
Well, you got your hands full.
It's the least I could do.
It's just a hot dog.
My mama taught me random acts of kindness make the world a better place.
Well, I can't argue with that.
Thank you.
- What is he, about 6 months? - Five and a half.
- He's really cute.
- He's got pipes you wouldn't believe.
Are you driving your mom crazy? No, no.
[CHILDREN YELLING, CHATTERING.]
Hoo.
Hoo.
Frog.
Ribbit.
This one yours? Here you go.
- Excuse me, Dr.
Weaver? - Yeah.
Something is weighing on my heart and I just can't take it anymore.
What's the problem? I gave Oscar Batista Lovastatin samples.
That sweet, hard-working man, I was afraid he would stop taking pills and come back here with a heart attack or stroke - Hope.
- That little boy.
Reminded me how moved I was by your piece.
- Thought some act of kindness might - Okay, okay, okay.
- And please forgive me, doctor - Okay, okay, stop.
You did a good thing.
Really.
There might be hope for you, Hope.
You told me those drug samples were for Dr.
Weaver's patient.
Well, they were, technically.
Well, technically, you lied to me.
There are rules for breaking the rules, and rule number one is that you never, ever lie to the nurses, you got me? I'm so sorry.
AMES: Fell off a ladder at work.
Dude wasn't paying attention, so I had to pay the price.
Oh, sounds like a dangerous job.
No, carpenter.
It's tough doing it with one arm, though.
Well, sprains heal pretty quickly.
Yeah, that's what they told me at the hospital.
Uh I'm headed for the red line.
Oh, I'm headed this way.
Well - Nice to meet you.
- Ha-ha.
You too.
- And thank you for the hot dog.
- It's my pleasure.
Catch you later, Joe.
Ha-ha.
Hey, any messages for me yet, Frank? No, Morris, the TV-producer lady has not called back yet.
You ask me one more time, I'm gonna slap you so hard you turn brunette.
Have you got that? - Position's been filled.
- What position? Stop calling the station.
I'm getting complaints.
Oh, that position, right.
They filled it, huh? - Mm-hm.
- Who did they find so fast? - Me.
- You? I thought you turned it down.
Yeah, well, I changed my mind.
Figured it was about time someone put something worthwhile on television.
[BUZZER SOUNDS.]
So, Smitty, how long you had the rash? About two weeks now.
- Got any food allergies? - No.
- You on any medications? - Just my blood-pressure pills.
All right, come on.
Have a seat.
What kind of pills? [SIGHS.]
Right.
Oh, you see, that's the problem.
Rash is a common reaction to enalapril.
Who prescribed these? Doc up at the clinic put me on them about 10 years ago.
This and something else.
- Ten years ago? Who gave you these? - Mm-hm.
See, my man, T-bone.
You know T.
Smitty, you can't take other people's medications, man.
It's not safe.
- Everybody does it.
- Everybody who? Up at First Mission Baptist, Pastor Watkins does a drug-exchange program.
You come up there sometime, man gives a powerful Okay, hold on, hold on.
He does a drug-exchange program? Hell, yeah.
I ain't got insurance.
You know how much this stuff costs? [EXHALES.]
[DOOR OPENS.]
You can't possibly think ultrasound was contraindicated.
- I do if it can't be done immediately.
- Could've told me before M and M.
Didn't realize I had to point out the obvious.
I can't win with you.
- Oh.
Finally, we agree on something.
- Finally.
- Yes.
- Yes.
Don't take piss out of me.
- Piss? Piss? - Yes.
Yes.
Yup, you've got a nice fluid pocket.
This is gonna be a snap.
Sam, draw up some 1 percent lido.
Whoa.
MARQUEZ: You're gonna feel a pinch.
- Okay, before I start, just a few things.
BO Y: I don't want a shot.
- Main risks here, bleeding and infection.
You could infect my heart? - Sterile technique makes it unlikely.
MOM: Mickey, calm down.
BO Y: No.
Aah.
Look, what about bleeding? I have trepidation about bleeding.
Well, it's only a minor risk, because we're using such a small needle.
Well, not so small, but thin.
And you'll be all numbed up so you won't feel a thing.
MARQUEZ: Relax.
BO Y: No, no.
Stop it.
Okey-dokey, let's do this.
[BO Y SCREAMING.]
Get that thing away from me, you clown.
I told you, I don't want that.
- You agreed to the procedure.
- Screw that.
Mr.
Payton.
And stop calling me that.
My name's Clyde Sandberg.
You people got short-term memory loss or something? Huh? - You ambushed me.
- You were spewing absurdities.
- Do you not like me? - You're a wanker.
- A wanker.
Ouch.
- Yeah, you're cocky, arrogant.
- And you're not smooth as you think.
- I'm not? - No, you're not.
- I never said I was.
[BOTH MOANING SOFTLY.]
[CLATTERING.]
- Mm.
- Mm.
I called the other night and a woman answered.
Yeah, I can explain that.
Now would be a good time.
[TABLE SCRAPING.]
[NEELA AND GATES MOANING.]
Here, here, bats-and-dolphins guy, I figured it out.
- It's DID.
- What? Dissociative Identity Disorder.
Multiple personalities? Psych make that diagnosis? No, I paged them.
They haven't come.
So this is based off of what? Your extensive psychiatric expertise? No, he's a classic presentation.
Old abuse injuries, keeps changing his name.
Maybe it's you that needs a psych evaluation.
No, I'm serious, Ray.
We have to double-doctor this guy.
Listen, he keeps refusing treatment, that effusion will kill him.
Who knows how long Psych will take? By the time their Resident sees him they present to the Attending, could be hours.
Double-doctoring, that's a big deal.
Can't we treat with NSAIDs and steroids? He's refusing vital treatment.
And that is grounds for a double-doctor.
Come on, get with me here.
- What, so I'm back on the case now? - Yeah.
Huh.
Look, I'll tell you what.
I'll talk to him.
I'll try and get some sort of read, but maybe you should hang back.
You already pissed him off enough today.
So I have a few questions for you.
Can you tell me what day it is? [SIGHS.]
Thursday.
Month and year? You know, they got this new thing out called a calendar.
My freaking God.
November, 2006.
- Do you know where you are? - What is this, Romper Room? I see stupid and retard and jerk-off.
I'm at County General Hospital.
RAY: I'm not double-doctoring.
- He's gonna get worse.
He's hypotensive with reduced cardiac output.
He hates doctors, especially you.
You wanna tie him, stick a needle in his chest? - Lf it'll save his life, hell, yeah.
- Ha-ha.
I am out, Archie.
Fine, I'll get somebody else.
Hey, Pratt.
No, no, no.
Hasta la bye-bye.
Pratt, I need you to sign off on a double-doctor.
[SIGHS.]
- Got a foster kid? - No, he's a competent adult.
Got pericardial effusion and doesn't want treatment.
Morris wants to get medieval because he thinks - I think he's DID.
- Multiple personalities.
Yeah, I know.
What did Psych say? They're MIA.
You know that multiple personality Dissociative Identity Disorder.
- Yeah, some docs don't think it exists.
- There's ton of literature to support it.
- Okay, his vitals? - Systolic's holding in the 90s.
- And mental status? - Alert and oriented.
Tox screen and CT? Clear.
Gotta treat him conservatively.
Wait for Psych, it's their call.
You want me to be thorough.
That's what I'm doing.
Pratt, listen to me for one second.
Pratt.
NEELA: If patient presents within a week of surgery, it's considered bounce-back.
Make sure bounce-backs Hey, can I speak to you for a sec? Wound seroma.
Removing the staples and packing the dermis.
I wasn't actually talking to you.
Oh.
Um Okay, go ahead.
I'll just get started.
So how's Surgery treating you? Like a stepchild.
Radiology's looking better every day.
It'll be over soon enough.
I hated my surgical rotation, anyway.
So do you like hockey? Tonsil or ice? [CHUCKLING.]
- Ice.
- Oh.
Mm.
Too bad.
But, yeah, I'll settle for a Hawks game.
[BOTH CHUCKLE.]
He's still refusing treatment? Last BP was 84/50 and he's developed pulsus paradoxus.
I found his old file.
Willis Payton is his real name, probably be the host personality.
This Clyde character must be one of his alters.
He was here a bunch of times between '88 and '96.
Foster kid, abuse-related injuries, some bad ones too.
It's classic DID history.
Psych's still a no-show? [SAM SIGHS.]
I know everybody down here thinks I'm a joke.
You know, if Pratt said DID, he'd be a genius.
[SCOFFS.]
But I know that I'm right about this.
And all I can do is suck on it and watch this guy die.
You did what you could.
And you're not a joke, Archie.
You're an Attending.
[SOFTLY.]
Thank you.
MAN: Was a time when that mountain seemed so high like it stretched up to the pearly gates themselves.
[PEOPLE AGREEING.]
Promised land seemed like an idea, like no matter how hard we worked it was only sand between our fingers.
[PHONE BEEPS.]
But we're still here.
Proud and strong, Lord have mercy, we're still here.
But we got a whole lot of work to do.
Because the more things change, the more they stay the same.
Young brother in the back.
You're new.
Stand up and introduce yourself.
No, no, you.
Ha-ha-ha.
[CHUCKLES.]
Evening, everyone.
I'm Greg Pratt.
Welcome, brother Pratt.
Come up front.
Nice to see young folk in the evening service, ain't it? [CROWD AGREEING.]
Your heart's getting worse, you know.
[SIGHS.]
Here we go again.
No.
You need me to spell it? If you keep refusing treatment, it's gonna go down one of two ways.
One, doctors are gonna come in here, tie you down and do the procedure.
They can't touch me, I got rights.
Or two, we get to watch you die.
Fun for you.
There's a third option.
You give consent, we fix your heart and you go home.
All we wanna do is help.
Yeah, you've been loads of help so far.
- I know you're scared.
- No, I ain't scared of nothing.
I know you've been hurt a lot.
But you are safe here.
I know you don't wanna trust us, but you can.
I promise.
[LIGHT BUZZING.]
[SOFTLY.]
I was Was Was I sleeping? No.
I lost time.
I lost time again.
[SIGHS THEN SNIFFS.]
Willis? Yeah? Clyde's been giving us a hard time.
Oh.
I thought he was gone.
You know about Clyde? Yeah.
My friends told me about him.
He's very negative.
Well, Clyde doesn't want us to help you.
So all we could do was give you some medicine but that's not working too well.
Um Wha? Can you? Can you still fix me? Willis, I need Clyde's permission.
I can't make him do anything.
I can't.
We can't start and stop again.
We're running out of time.
No.
No, no, no.
No.
[SHOUTING.]
Willis.
Damn it, let me talk to Clyde right now.
Do not make me hurt you.
Let me talk to Clyde.
How many times I gotta tell you to get off me, bitch? Huh? How many times? Huh? I saw Willis.
- He's letting us do the procedure.
- He's a pansy.
Yeah, well, he's brave enough to let us stick a needle in his heart.
Piss off, bitch.
Fine.
You be a tough guy all the way to your funeral.
I'm done.
Hey.
[EXHALES.]
You stick my heart, that means I get out of here, right? Yup.
Do it.
I told you, I ain't scared of nothing.
The drug-exchange program is only for people who have prescriptions but can't afford the drugs.
Smitty's prescription was 10 years old, and he had enalapril.
Enalapril is not the first drug of choice for black folks with high blood pressure.
Look, I suggest that you start an exercise program.
Get your congregation to stop eating salt and fried foods and start exercising.
Trust me, you'll do a whole lot more good.
We don't just help people with high blood pressure.
We have diabetics, asthmatics, you name it.
Look, what you're doing is dangerous, okay? Not to mention illegal.
[SIGHS.]
I have an obligation to this community, Dr.
Pratt.
These people are shackled by a system over which they have no control.
- Yeah.
- The one thing I will not do is nothing.
Excuse me, Dr.
Morris? - Can I ask your advice on something? - Yeah.
I lied to Samantha about something, and now she's really steamed.
Oh, bad move.
Piss one nurse off, piss them all off, like the Mafia.
You know, whenever I'm in a precarious situation I always ask myself, "What would Jesus do?" Right.
What would Jesus do if the nurses hated him? Well, he would do the right thing, of course.
That's the problem.
See, I thought I was doing the right thing.
I guess I just did it the wrong way.
Hey, the story of my life.
You know, sometimes it doesn't matter how much we kick and scream.
Even when we're right.
The prophet is without honor in his own land.
Matthew 13:54.
Oh, I love that one.
Big Matthew fan.
[LAUGHS.]
You have a good night, Dr.
Morris.
Feeling better? Drained half a liter of fluid from around your heart.
Blood pressure and pulse are back to normal.
Soon as a bed opens up, we'll get you upstairs to a room.
So you're doing great.
[SOFTLY.]
You got my glasses? Let me check.
Yeah.
[CHUCKLES.]
Okay.
[SNIFFLES.]
That kid gonna be okay? Who? MORRIS: Yeah.
I'm sure he is.
Looks like he's leaving.
He was racing a Hot Wheels.
His mom, she was mean.
[SNIFFLING.]
Um Willis? [CHUCKLES.]
My name's Andre.
I like Hot Wheels.
I wish his mom wasn't so mean.
Hey, hey.
[VOICE BREAKING.]
Don't tell my dad I'm here, okay? He can be pretty mean too.
[CRYING.]
[QUIETLY.]
Yeah.
Your secret's safe with me.
Okay? It's kind of dark in here.
You're not gonna leave, are you? No.
No way, buddy, no.
I'm here all night.
[CHUCKLES.]
That's good.
[PULLS UP CHAIR.]
[CLEARS THROAT.]
So, what kind of Hot Wheels you got? All kinds.
I collect them.
Yeah? I used to collect them too.
[CHUCKLES.]
What kind you got? I used to have a '57 Chevy.
- Heh.
I got that one.
- You got that.
Shelby Cobra.
Got it.
Okay, all right.
'65 Mustang Fastback.
Heh.
I got two.
- You got two? - Yeah.
[LAUGHS.]
Wow.
I used to have three, but I gave one to my friend.
You'll have to give one to me.
I don't think I have mine anymore.
Okay, I'll give it to you.
What else did you have?